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01-01-2021 | Pancreatectomy | Original Scientific Report

European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications After Hepatectomy and Pancreatectomy

Authors: Yasuyuki Fukami, Takuya Saito, Takashi Arikawa, Takaaki Osawa, Shunichiro Komatsu, Kenitiro Kaneko, Yuria Ishida, Keisuke Maeda, Naoharu Mori, Tsuyoshi Sano

Published in: World Journal of Surgery | Issue 1/2021

Abstract

Background

Recently, diagnostic criteria for malnutrition have been proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN). This study aimed to investigate the utility of the ESPEN malnutrition criteria as a predictor for major complications following hepatectomy and pancreatectomy.

Methods

Data were reviewed from 176 consecutive patients who underwent hepatectomy (n = 103) or pancreatectomy (n = 73) between November 2017 and December 2019. Patients were divided into two groups according to the ESPEN malnutrition criteria using a prospectively collected database. The clinical data and the surgical outcomes of patients in the malnourished and normal groups were retrospectively analyzed.

Results

Thirty-five (20%) patients were diagnosed with malnourishment according to ESPEN criteria. The malnourished group had a significantly low preoperative albumin concentration (p = 0.001). After hepatectomy, major complications (Clavien grade ≥ 3a) occurred significantly more frequently in the malnourished group than in the normal group (p = 0.013). Multivariate analysis indicated that operative duration ≥ 300 min (hazard ratio: 22.47, 95% CI: 2.17 to 232.73, p = 0.009) and malnourishment (hazard ratio: 14.56, 95% CI: 2.58 to 82.17, p = 0.002) were independently associated with major complications after hepatectomy. On the other hand, malnutrition was not associated with major complications after pancreatectomy.

Conclusions

The ESPEN malnutrition criteria are a valuable predictor for major complications following hepatectomy.

Sadot E, Groot Koerkamp B, Leal JN, Shia J, Gonen M, Allen PJ et al (2015) Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer: surgical technique or biologic surrogate? Ann Surg 262:476–485 Discussion 483–485CrossRef

Gemenetzis G, Groot VP, Blair AB, Laheru DA, Zheng L, Narang AK et al (2019) Survival in locally advanced pancreatic cancer after neoadjuvant therapy and surgical resection. Ann Surg 270:340–347CrossRef

Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T (2006) One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg 244:240–247CrossRef

Fukami Y, Kaneoka Y, Maeda A, Kumada T, Tanaka J, Akita T et al (2019) Liver resection for multiple hepatocellular carcinomas: a Japanese nationwide survey. Ann Surg. https://doi.org/10.1097/SLA.0000000000003192 [Epub ahead of print]CrossRef

Spolverato G, Ejaz A, Hyder O, Kim Y, Pawlik TM (2014) Failure to rescue as a source of variation in hospital mortality after hepatic surgery. Br J Surg 101:836–846CrossRef

Hartwig W, Gluth A, Hinz U, Koliogiannis D, Strobel O, Hackert T et al (2016) Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer. Br J Surg 103:1683–1694CrossRef

Gani F, Hundt J, Makary MA, Haider AH, Zogg CK, Pawlik TM (2016) Financial impact of postoperative complication following hepato-pancreatico-biliary surgery for cancer. Ann Surg Oncol 23:1064–1070CrossRef

Wang J, Ma R, Churilov L, Eleftheriou P, Nikfarjam M, Christophi C et al (2018) The cost of perioperative complications following pancreaticoduodenectomy: a systematic review. Pancreatology 18:208–220CrossRef

Kuzu MA, Terzioğlu H, Genç V, Erkek AB, Ozban M, Sonyürek P et al (2006) Preoperative nutritional risk assessment in predicting postoperative outcome in patients undergoing major surgery. World J Surg 30:378–390. https://doi.org/10.1007/s00268-005-0163-1CrossRefPubMed

10.

Braga M, Gianotti L, Nespoli L, Radaelli G, Di Carlo V (2002) Nutritional approach in malnourished surgical patients: a prospective randomized study. Arch Surg 137:174–180CrossRef

11.

Schiesser M, Kirchhoff P, Müller MK, Schäfer M, Clavien PA (2009) The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery 145:519–526CrossRef

12.

Probst P, Haller S, Bruckner T, Ulrich A, Strobel O, Hackert T et al (2017) Prospective trial to evaluate the prognostic value of different nutritional assessment scores in pancreatic surgery (NURIMAS Pancreas). Br J Surg 104:1053–1062CrossRef

13.

McKenna NP, Bews KA, Al-Refaie WB, Colibaseanu DT, Pemberton JH, Cima RR et al (2020) Assessing malnutrition before major oncologic surgery: one size does not fit all. J Am Coll Surg 230:451–460CrossRef

14.

Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S et al (2015) Diagnostic criteria for malnutrition—An ESPEN consensus statement. Clin Nutr 34:335–340CrossRef

15.

Rondel ALMA, Langius JAE, de van der Schueren MAE, Kruizenga HM (2018) The new ESPEN diagnostic criteria for malnutrition predict overall survival in hospitalised patients. Clin Nutr 37:163–168CrossRef

16.

Ye XJ, Ji YB, Ma BW, Huang DD, Chen WZ, Pan ZY et al (2018) Comparison of three common nutritional screening tools with the new European society for clinical nutrition and metabolism (ESPEN) criteria for malnutrition among patients with geriatric gastrointestinal cancer: a prospective study in China. BMJ Opens 8(4):e019750CrossRef

17.

Maeda K, Ishida Y, Nonogaki T, Mori N (2020) Reference body mass index values and the prevalence of malnutrition according to the Global leadership Initiative on malnutrition criteria. Clin Nutr 39:180–184CrossRef

18.

Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R et al (2020) Malnutrition at admission predicts in-hospital falls in hospitalized older adults. Nutrients 12(2):E541CrossRef

19.

Ix JH, Wassel CL, Stevens LA, Beck GJ, Froissart M, Navis G et al (2011) Equations to estimate creatinine excretion rate: the CKD epidemiology collaboration. Clin J Am Soc Nephrol 6:184–191CrossRef

20.

Jassal SK, Wassel CL, Laughlin GA, Barrett-Connor E, Rifkin DE, Ix JH (2015) Urine creatinine-based estimates of fat-free mass in community-dwelling older persons: the Rancho Bernardo study. J Ren Nutr 25:97–102CrossRef

21.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

22.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRef

23.

Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688CrossRef

24.

Rojer AG, Kruizenga HM, Trappenburg MC, Reijnierse EM, Sipilä S, Narici MV et al (2016) The prevalence of malnutrition according to the new ESPEN definition in four diverse populations. Clin Nutr 35:758–762CrossRef

25.

van der Sijp MPL, van Eijk M, Krijnen P, Schipper IB, Achterberg WP, Niggebrugge AHP (2018) Screening for malnutrition in patients admitted to the hospital with a proximal femoral fracture. Injury 49:2239–2243CrossRef

26.

Schiesser M, Müller S, Kirchhoff P, Breitenstein S, Schäfer M, Clavien PA (2008) Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin Nutr 27:565–570CrossRef

27.

Laky B, Janda M, Cleghorn G, Obermair A (2008) Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr 87:1678–1685CrossRef

28.

Gabrielson DK, Scaffidi D, Leung E, Stoyanoff L, Robinson J, Nisenbaum R et al (2013) Use of an abridged scored patient-generated subjective global assessment (abPG-SGA) as a nutritional screening tool for cancer patients in an outpatient setting. Nutr Cancer 65:234–239CrossRef

29.

Huang TH, Hsieh CC, Kuo LM, Chang CC, Chen CH, Chi CC et al (2019) Malnutrition associated with an increased risk of postoperative complications following hepatectomy in patients with hepatocellular carcinoma. HPB (Oxford) 21:1150–1155CrossRef

30.

Gaujoux S, Cortes A, Couvelard A, Noullet S, Clavel L, Rebours V et al (2010) Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy. Surgery 148:15–23CrossRef

31.

Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ et al (2007) Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg 246:1058–1064CrossRef

Title: European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications After Hepatectomy and Pancreatectomy
Authors: Yasuyuki Fukami
Takuya Saito
Takashi Arikawa
Takaaki Osawa
Shunichiro Komatsu
Kenitiro Kaneko
Yuria Ishida
Keisuke Maeda
Naoharu Mori
Tsuyoshi Sano
Publication date: 01-01-2021
Publisher: Springer International Publishing
Keywords: Pancreatectomy
Nutrition
Malnutrition
Published in: World Journal of Surgery / Issue 1/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05767-w

At a glance: The STEP trials

Springer Medicine

European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications After Hepatectomy and Pancreatectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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