Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis

Frontiers in Nutrition

Nutrition

Gennaro Nappo¹  Alessandro Zerbi¹  Giovanni Capretti¹  Danila Azzolina²  Ilaria Trestini³  Marta Sandini⁴  Giuseppe Malleo⁵  Matteo De Pastena⁵  Salvatore Paiella⁵  Laura Maggino⁵  Erica Secchettin⁵  Roberto Salvia⁵  Claudio Bassi⁵  Pier Giuseppe Vacca⁵  Carlo Ingaldi⁶  Riccardo Casadei⁶  Claudio Ricci⁶  Giulia Zamboni⁷  Giancarlo Mansueto⁷  Luca Gianotti⁸  Marco Cereda⁸  Michele Milella⁹  Maria Assunta Corciulo^1,10  Dario Gregori^1,10 

[1] Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy;IRCCS Humanitas Research Hospital, Rozzano, Italy;Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy;Dietetics Services, Hospital Medical Direction, University Hospital Trust of Verona, Verona, Italy;General Surgery Unit, University of Siena, Siena, Italy;General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy;Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy;Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy;Radiology Unit, Pancreas Institute, University of Verona, Verona, Italy;School of Medicine and Surgery, University of Milano-Bicocca and HPB Unit, San Gerardo Hospital Monza, Monza, Italy;Section of Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy;Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy;

关键词: pancreatic cancer;    nutrition–clinical;    body composition;    postoperative complications;    inflammation;   

DOI  :  10.3389/fnut.2023.1065294

 received in 2022-10-09, accepted in 2023-01-23,  发布年份 2023

来源: Frontiers

【 摘 要 】

Background and aimsBody composition parameters and immunonutritional indexes provide useful information on the nutritional and inflammatory status of patients. We sought to investigate whether they predict the postoperative outcome in patients with pancreatic cancer (PC) who received neoadjuvant therapy (NAT) and then pancreaticoduodenectomy.MethodsData from locally advanced PC patients who underwent NAT followed by pancreaticoduodenectomy between January 2012 and December 2019 in four high-volume institutions were collected retrospectively. Only patients with two available CT scans (before and after NAT) and immunonutritional indexes (before surgery) available were included. Body composition was assessed and immunonutritional indexes collected were: VAT, SAT, SMI, SMA, PLR, NLR, LMR, and PNI. The postoperative outcomes evaluated were overall morbidity (any complication occurring), major complications (Clavien-Dindo ≥ 3), and length of stay.ResultsOne hundred twenty-one patients met the inclusion criteria and constituted the study population. The median age at the diagnosis was 64 years (IQR16), and the median BMI was 24 kg/m2 (IQR 4.1). The median time between the two CT-scan examined was 188 days (IQR 48). Skeletal muscle index (SMI) decreased after NAT, with a median delta of −7.8 cm2/m2 (p < 0.05). Major complications occurred more frequently in patients with a lower pre-NAT SMI (p = 0.035) and in those who gained in subcutaneous adipose tissue (SAT) compartment during NAT (p = 0.043). Patients with a gain in SMI experienced fewer major postoperative complications (p = 0.002). The presence of Low muscle mass after NAT was associated with a longer hospital stay [Beta 5.1, 95%CI (1.5, 8.7), p = 0.006]. An increase in SMI from 35 to 40 cm2/m2 was a protective factor with respect to overall postoperative complications [OR 0.43, 95% (CI 0.21, 0.86), p < 0.001]. None of the immunonutritional indexes investigated predicted the postoperative outcome.ConclusionBody composition changes during NAT are associated with surgical outcome in PC patients who receive pancreaticoduodenectomy after NAT. An increase in SMI during NAT should be favored to ameliorate the postoperative outcome. Immunonutritional indexes did not show to be capable of predicting the surgical outcome.

【 授权许可】

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Copyright © 2023 Paiella, Azzolina, Trestini, Malleo, Nappo, Ricci, Ingaldi, Vacca, De Pastena, Secchettin, Zamboni, Maggino, Corciulo, Sandini, Cereda, Capretti, Casadei, Bassi, Mansueto, Gregori, Milella, Zerbi, Gianotti and Salvia.