Skeletal Muscle Depletion and Nutrition Support Affected Postoperative Complications in Patients Underwent Pancreatoduodenectomy

BackgroundPostoperative complications remain high in patients underwent pancreaticoduodenectomy (PD). Body composition has been shown closely related to the outcome in critical and surgical patients. The aim of the present study was to investigate whether preoperative skeletal muscle condition and postoperative nutrition would affect major complications in patients underwent PD.MethodsThis retrospective study included 265 patients underwent PD with a CT scan of the abdomen within 1 week before surgery. Body compartment data was extracted from the L3 level of the CT scan, which included skeletal muscle area and density, subcutaneous and visceral fat area. Univariable and multivariable regression analyses were performed to investigate correlations between the above variables and postoperative complications. Furthermore, a subgroup analysis was conducted to explore the relationship between postoperative nutrition strategy and the outcome.ResultsOf all the 265 patients, the mean age and BMI was 59.5±13.9 years and 23.1 ±3.6 kg/m2, respectively. Major complications occurred in 81 patients (30.6%). Cutoff values for skeletal muscle depletion were defined by ROC curve analysis from postoperative complications in skeletal muscle index (SMI) (male 47.32 cm2/m2 and female 40.65 cm2/m2). Univariable analysis showed postoperative complications were significantly associated with age, sex, systemic comorbidity, SMI, skeletal muscle density (SMD) and visceral adipose tissue index (VATI). Multivariable regression reveled only age (OR 1.49, 95% CI 1.22-1.83, p=0.026), SMI (OR 0.77, 95%CI 0.51-0.94, p=0.015) and SMD (OR 0.85, 95%CI 0.64-1.03, p=0.029) were independent predictors for major complications. Subgroup analysis showed the initial parenteral nutrition time (IPNT) (OR1.89, 95% CI 1.43-2.49, p=0.032) and average protein delivery (APD) (OR 0.76, 95% CI 0.53-0.89, p=0.021) were significantly associated with major complications in patients with lower SMI. However, in normal SMI patients, such association was not significant enough.ConclusionsPreoperative skeletal muscle index and density were independently associated with major complications in patients underwent PD. In patients with lower SMI, early parenteral nutrition and higher protein delivery were related to better outcome.

Early implementation of a postoperative nutrition support pathway for patients undergoing esophagectomy.

344 Background: A significant risk of malnutrition burdens patients with esophageal cancer undergoing esophagectomy as tumor-related dysphagia and side effects of chemoradiation impair the patients’ ability to maintain adequate nutrition. Moreover, patients lose 10% or more of their preoperative body weight in the first year following surgery. Implementation of nutrition protocols may reduce postoperative weight loss and enhance recovery in these patients. Methods: This is a retrospective study examining a postoperative nutrition protocol initiated in August of 2017. Patients with esophagogastric cancer who underwent Ivor Lewis esophagectomy from July 2016 to July 2019 were identified from a prospectively collected database. Patients that underwent surgery after implementation of this protocol were compared to those operated prior to it. Results: Patients’ and tumor characteristics were similar between the two groups. The protocol included preoperative evaluation by a dietician, postoperative feeding pathway, and regular post-discharge follow up by phone with a dietician. In the post protocol group, we observed a reduction in time to initiation of diet and decreased weight loss at patient follow up (Table). There was no difference in incidence of postoperative complication, length of stay, 30-day readmission, or in hospital mortality. Conclusions: In conclusion, postoperative nutrition support programs may help reduce postoperative weight loss and may have a role in the prevention of malnutrition in these patients. Initial results suggest that more aggressive nutritional supplement program is feasible and may lead to improved postoperative outcomes in patients undergoing esophagectomy. [Table: see text]