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Original Articles
- Clinical Impact of Preoperative Sarcopenia to Postoperative Prognosis in Patients with Periampullary Malignancy: Retrospective Multicenter Study
- Jee Hyun Park, Youngju Ryu, So Hee Song, Naru Kim, Sang Hyun Shin, Jin Seok Heo, Dong Wook Choi, Woo Kyoung Jeong, Woo Hyun Jung, Yong Chan Shin, Chang-Sup Lim, In Woong Han
- Surg Metab Nutr 2020;11(2):40-45. Published online December 30, 2020
- DOI: https://doi.org/10.18858/smn.2020.11.2.40
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Abstract
PDF - Purpose: This study compared the preoperative nutritional status between sarcopenic and non-sarcopenic patients and examined the effects of sarcopenia on the prognosis after a pancreatoduodenectomy (PD).
Materials and Methods: From 2015 to 2016, 480 patients who underwent PD with periampullary cancer at Samsung Medical Center, Seoul National University Boramae Medical Center, Ilsan Paik Hospital, and Ajou University Hospital were analyzed retrospectively. Sarcopenia was measured from the cross-sectional visceral fat and muscle area on CT imaging using an automatic calculation program. The dysnutritional grade was assessed according to Controlling Nutritional Status (CONUT) score system.
Results: Preoperative serum albumin (3.9 g/dl) and cholesterol levels (161.7 mg/dl) of sarcopenic patients were significantly lower than those of the non-sarcopenia patients (4.0 g/dl, P=0.024; 176.1 mg/dl, P=0.005). The proportion of moderate-to-severe dysnutritional grade in sarcopenic patients was significantly higher than in the non-sarcopenic patients (20.0 vs. 8.1%, P=0.004). A comparison of the changes in albumin between before and after PD showed a decrease in sarcopenic patients (0.06 vs. 0.05, P=0.024). Sarcopenia itself was not a factor affecting the overall survival (OS) negatively, but moderate-to-severe dysnutritional grade was an independent risk factor for OS (HR 2.418, CI 1.424~4.107, P=0.001).
Conclusion: Patients with sarcopenia showed poorer preoperative nutritional status than those without sarcopenia, and the sarcopenia affected the postoperative nutritional status negatively. No direct correlation was observed between sarcopenia and OS, but the dysnutritional grade was an independent risk factor that affects OS. As a result, patients with sarcopenia could be affected indirectly for survival because of their poor nutritional status.
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- Recovery Pattern of the Nutritional Status after Surgical Treatment for Pancreatic Head Disease: Compared with Malignancy and Non-malignancy
- Eunjung Kim, Youngmin Han, Hongbeom Kim, Wooil Kwon, Sun-Whe Kim, Jin-Young Jang
- Surg Metab Nutr 2018;9(2):51-58. Published online December 30, 2018
- DOI: https://doi.org/10.18858/smn.2018.9.2.51
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Abstract
PDF
Purpose:
Malnutrition affects the clinical outcomes of pancreatic disease. On the other hand, the changes in the nutritional status stratified by malignant and non-malignant diseases after surgery still need to be determined. The aim was to confirm the changing nutritional status and clinical outcomes after a pancreatoduodenectomy according to malignant and non-malignant disease.
Materials and Methods:
Data were collected prospectively from 157 patients between 2009 and 2015. The nutritional status was classified as well-nourished, at-risk of malnutrition, and malnourished by a Mini Nutrition Assessment. The clinical outcomes were assessed using the postoperative complication, hospital stay, biochemical nutritional markers, and quality-of-life (QOL).
Results:
Preoperatively, the proportion of malnourished status in the malignant disease group (group B) were 66.7% and 33.3% in the non-malignancy group (group A). The malnutrition rate in group B was higher than that in group A at 3, 6, and 12 months after surgery (58.1% vs. 41.9%, 90.0% vs. 10.0, 77.8% vs. 22.2%, respectively). The preoperative QOL was significantly lower in group B than in group A (P<.001); however, the QOL was comparable between the two groups after surgery. The body mass index was unrecovered after surgery in all groups.
Conclusion:
Patients with malignant pancreatic disease are more likely to suffer from a poor nutritional status than those with non-malignant pancreatic disease. One year after the pancreatoduodenctomy, the at-risk of malnutrition and malnourished rate were found to be over 70% in all patients. Therefore, more efforts will be needed to improve the nutritional status in pancreatic head disease.
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