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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2020

01-12-2020 | Pancreatic Surgery | Pancreatic Tumors

Prognostic Impact of Preoperative Nutritional Risk in Patients Who Undergo Surgery for Pancreatic Adenocarcinoma

Authors: Ilaria Trestini, BSc, Salvatore Paiella, MD, PhD, Marta Sandini, MD, Isabella Sperduti, PhD, Giovanni Elio, MD, Tommaso Pollini, MD, Davide Melisi, MD, PhD, Alessandra Auriemma, MD, Caterina Soldà, MD, Clelia Bonaiuto, BSc, Daniela Tregnago, BSc, Alice Avancini, MSc, PhD, Erica Secchettin, PharmD, Deborah Bonamini, MSc, Massimo Lanza, MSc, Sara Pilotto, MD, PhD, Giuseppe Malleo, MD, PhD, Roberto Salvia, MD, PhD, Chiara Bovo, MD, Luca Gianotti, MD, PhD, Claudio Bassi, MD, FACS, FRCS, FEBS, FASA (Hon.), Michele Milella, MD

Published in: Annals of Surgical Oncology | Issue 13/2020

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Abstract

Background

Nutritional derangements are common hallmarks of pancreatic cancer (PC). Their early detection and management are usually overlooked in routine practice. This study aimed to explore preoperative nutritional status and its prognostic value in patients undergoing surgery for PC.

Methods

Data from 73 patients who underwent surgery for PC from November 2015 to January 2018 at the General and Pancreatic Surgery Unit, The Pancreas Institute, University Hospital of Verona Hospital, Verona, Italy, were retrospectively evaluated. The Nutritional Risk Screening (NRS)-2002 was used to evaluate the preoperative nutritional risk. Body composition was assessed using bioimpedance vectorial analysis (BIVA) on the day prior to surgery. The effect of clinical, pathological, and nutritional characteristics on overall survival (OS) was investigated using a Cox and logistic regression model. Kaplan–Meier curves were compared using the log-rank test.

Results

Most patients (80.8%) were at preoperative risk of malnutrition (NRS-2002 ≥ 3) despite a mean BMI of 24.1 kg/m2(± 4.3). Twenty-four patients (32.9%) received neoadjuvant therapy prior to surgery. Preoperative NRS-2002 was significantly higher in this subset of patients (p = 0.026), with a significant difference by chemotherapy regimens (in favor of FOLFIRINOX, p = 0.035). In a multivariate analysis, the only independent prognostic factor for OS was the NRS-2002 score (HR 5.24, p = 0.013). Particularly, the likelihood of 2-year survival was higher in NRS < 3 (p = 0.009).

Conclusions

Our analysis confirms that preoperative malnutrition has a detrimental impact on OS in PC patients undergoing radical surgery for PC. Careful preoperative nutritional evaluation of PC patients should be mandatory, especially in those who are candidates for neoadjuvant therapy.
Appendix
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Metadata
Title
Prognostic Impact of Preoperative Nutritional Risk in Patients Who Undergo Surgery for Pancreatic Adenocarcinoma
Authors
Ilaria Trestini, BSc
Salvatore Paiella, MD, PhD
Marta Sandini, MD
Isabella Sperduti, PhD
Giovanni Elio, MD
Tommaso Pollini, MD
Davide Melisi, MD, PhD
Alessandra Auriemma, MD
Caterina Soldà, MD
Clelia Bonaiuto, BSc
Daniela Tregnago, BSc
Alice Avancini, MSc, PhD
Erica Secchettin, PharmD
Deborah Bonamini, MSc
Massimo Lanza, MSc
Sara Pilotto, MD, PhD
Giuseppe Malleo, MD, PhD
Roberto Salvia, MD, PhD
Chiara Bovo, MD
Luca Gianotti, MD, PhD
Claudio Bassi, MD, FACS, FRCS, FEBS, FASA (Hon.)
Michele Milella, MD
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08515-5

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