Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis
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 the...
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2023.1065294/full |
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| author | Salvatore Paiella Danila Azzolina Ilaria Trestini Giuseppe Malleo Gennaro Nappo Gennaro Nappo Claudio Ricci Claudio Ricci Carlo Ingaldi Carlo Ingaldi Pier Giuseppe Vacca Matteo De Pastena Erica Secchettin Giulia Zamboni Laura Maggino Maria Assunta Corciulo Marta Sandini Marco Cereda Giovanni Capretti Giovanni Capretti Riccardo Casadei Riccardo Casadei Claudio Bassi Giancarlo Mansueto Dario Gregori Michele Milella Alessandro Zerbi Alessandro Zerbi Luca Gianotti Roberto Salvia |
| author_facet | Salvatore Paiella Danila Azzolina Ilaria Trestini Giuseppe Malleo Gennaro Nappo Gennaro Nappo Claudio Ricci Claudio Ricci Carlo Ingaldi Carlo Ingaldi Pier Giuseppe Vacca Matteo De Pastena Erica Secchettin Giulia Zamboni Laura Maggino Maria Assunta Corciulo Marta Sandini Marco Cereda Giovanni Capretti Giovanni Capretti Riccardo Casadei Riccardo Casadei Claudio Bassi Giancarlo Mansueto Dario Gregori Michele Milella Alessandro Zerbi Alessandro Zerbi Luca Gianotti Roberto Salvia |
| author_sort | Salvatore Paiella |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T10:09:51Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2296-861X |
| language | English |
| last_indexed | 2024-03-13T10:09:51Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nutrition |
| spelling | doaj.art-c5215ff322ea4a988a2236381f6507d42023-05-22T07:03:17ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2023-02-011010.3389/fnut.2023.10652941065294Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysisSalvatore Paiella0Danila Azzolina1Ilaria Trestini2Giuseppe Malleo3Gennaro Nappo4Gennaro Nappo5Claudio Ricci6Claudio Ricci7Carlo Ingaldi8Carlo Ingaldi9Pier Giuseppe Vacca10Matteo De Pastena11Erica Secchettin12Giulia Zamboni13Laura Maggino14Maria Assunta Corciulo15Marta Sandini16Marco Cereda17Giovanni Capretti18Giovanni Capretti19Riccardo Casadei20Riccardo Casadei21Claudio Bassi22Giancarlo Mansueto23Dario Gregori24Michele Milella25Alessandro Zerbi26Alessandro Zerbi27Luca Gianotti28Roberto Salvia29General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, ItalyDepartment of Environmental and Preventive Science, University of Ferrara, Ferrara, ItalyDietetics Services, Hospital Medical Direction, University Hospital Trust of Verona, Verona, ItalyGeneral and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, ItalyIRCCS Humanitas Research Hospital, Rozzano, ItalyPancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, ItalyDepartment of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, ItalyPancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, ItalyDepartment of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, ItalyGeneral and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, ItalyGeneral and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, ItalyGeneral and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, ItalyRadiology Unit, Pancreas Institute, University of Verona, Verona, ItalyGeneral and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, ItalyUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy0General Surgery Unit, University of Siena, Siena, Italy1School of Medicine and Surgery, University of Milano-Bicocca and HPB Unit, San Gerardo Hospital Monza, Monza, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, ItalyIRCCS Humanitas Research Hospital, Rozzano, ItalyPancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, ItalyDepartment of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, ItalyGeneral and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, ItalyRadiology Unit, Pancreas Institute, University of Verona, Verona, ItalyUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy2Section of Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, ItalyIRCCS Humanitas Research Hospital, Rozzano, Italy1School of Medicine and Surgery, University of Milano-Bicocca and HPB Unit, San Gerardo Hospital Monza, Monza, ItalyGeneral and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, ItalyBackground 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.https://www.frontiersin.org/articles/10.3389/fnut.2023.1065294/fullpancreatic cancernutrition–clinicalbody compositionpostoperative complicationsinflammation |
| spellingShingle | Salvatore Paiella Danila Azzolina Ilaria Trestini Giuseppe Malleo Gennaro Nappo Gennaro Nappo Claudio Ricci Claudio Ricci Carlo Ingaldi Carlo Ingaldi Pier Giuseppe Vacca Matteo De Pastena Erica Secchettin Giulia Zamboni Laura Maggino Maria Assunta Corciulo Marta Sandini Marco Cereda Giovanni Capretti Giovanni Capretti Riccardo Casadei Riccardo Casadei Claudio Bassi Giancarlo Mansueto Dario Gregori Michele Milella Alessandro Zerbi Alessandro Zerbi Luca Gianotti Roberto Salvia Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis Frontiers in Nutrition pancreatic cancer nutrition–clinical body composition postoperative complications inflammation |
| title | Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis |
| title_full | Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis |
| title_fullStr | Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis |
| title_full_unstemmed | Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis |
| title_short | Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis |
| title_sort | body composition parameters immunonutritional indexes and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy a retrospective multicenter analysis |
| topic | pancreatic cancer nutrition–clinical body composition postoperative complications inflammation |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2023.1065294/full |
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