Nutritional predictors of postoperative outcome in pancreatic cancer

Background: Nutritional status plays an important role in the incidence of postoperative complications and the prognosis of various tumours. The prognostic value of preoperative nutritional factors in patients with pancreatic cancer is not known. Methods: This retrospective study included 268 patien...

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Bibliographic Details
Published in:British journal of surgery 2011-02, Vol.98 (2), p.268-274
Main Authors: Kanda, M., Fujii, T., Kodera, Y., Nagai, S., Takeda, S., Nakao, A.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Body Mass Index
Female
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Humans
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Metabolic diseases
Middle Aged
Nutritional Status
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - surgery
Postoperative Complications - etiology
Postoperative Complications - mortality
Preoperative Care - mortality
Prognosis
Retrospective Studies
Risk Factors
Treatment Outcome
Tumors
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Summary:Background: Nutritional status plays an important role in the incidence of postoperative complications and the prognosis of various tumours. The prognostic value of preoperative nutritional factors in patients with pancreatic cancer is not known. Methods: This retrospective study included 268 patients who underwent resection for adenocarcinoma of the pancreas. The predictive value of preoperative nutritional status for postoperative outcome (survival, complications) was assessed. Nutritional factors included the three constitutional indices, serum albumin and Onodera's prognostic nutrition index (PNI), calculated as 10 × serum albumin (g/dl) + 0·005× total lymphocyte count (per mm3). Results: In multivariable analysis preoperative low PNI (but not low albumin) was an independent prognostic factor for poor survival: hazard ratio (HR) 1·73 (95 per cent confidence interval (c.i.) 1·21 to 2·47). The accuracy of a PNI value of less than 45 as cut‐off for clinically significant preoperative malnutrition in predicting 1‐ or 2‐year survival after surgery was, however, limited (66·4 and 56·3 per cent respectively). Low preoperative albumin concentration and PNI were significantly associated with postoperative complications: odds ratio 1·98 (95 per cent c.i. 1·18 to 3·32) and 2·14 (1·23 to 3·73) respectively. Low PNI and low body mass index were independently associated with pancreatic fistula: HR 2·52 (1·37 to 4·63) and 0·40 (0·17 to 0·93) respectively. Conclusion: The PNI is associated with overall survival and postoperative complications, in particular pancreatic fistula, in patients with pancreatic cancer. The moderate accuracy of PNI as a predictor of survival limits its clinical use. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Nutritional status predicts survival reasonably well
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.7305