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Defining postoperative weight change after pancreatectomy: Factors associated with distinct and dynamic weight trajectories

Published:September 14, 2020DOI:https://doi.org/10.1016/j.surg.2020.07.056

      Abstract

      Background

      Weight change offers the simplest indication of a patient’s recovery after an operation. There have been no studies that have thoroughly investigated postoperative weight dynamics after pancreatectomy. The aim of this study was to define postoperative weight change after a pancreatectomy and determine factors associated with optimal and poor weight trajectories.

      Methods

      From 2004 to 2019, 1,090 proximal (65%) and distal (35%) pancreatectomies were performed in patients with adequate data in the medical records. Patient weights were acquired preoperatively and at postoperative months 1, 3, and 12. Optimal (top quartile, weight restoration) and poor (bottom quartile, persistent weight loss) postoperative weight cohorts were identified at 1 year postoperatively.

      Results

      The median percentage weight change 1 year postpancreatectomy was –6.6% (interquartile range: –1.4% to –12.5%), –7.8% for proximal pancreatectomy, and –4.2% for distal pancreatectomy. For most patients (interquartile range cohort), the median percentage weight change at 1, 3, and 12 months was –6.2%, –7.2%, and –6.6%. The independent factors associated with weight restoration were age <65, nonobesity (body mass index <30kg/m2), receiving total parenteral nutrition/total enteral nutrition preoperatively, experiencing preoperative weight loss >10%, distal pancreatectomy, not undergoing vascular resection, and no readmission within 30 days. Conversely, persistent weight loss was associated with American Society of Anesthesiologists classes III to IV, obesity, malignancy, proximal pancreatectomy, blood loss ≥350mL, and experiencing readmission within 30 days. Focusing on pancreatic ductal adenocarcinoma (n = 372) patients, the factors associated with persistent weight loss were obesity, proximal pancreatectomy, and experiencing recurrence within 1 year; however, weight cohorts were not associated with overall survival for pancreatic ductal adenocarcinoma patients.

      Conclusion

      These data define weight kinetics after pancreatectomy. Ultimately, postoperative weight trajectories appear to be largely predetermined but may be mitigated by limiting readmissions and complications. Clinicians should use these data to identify patients who continue to lose weight between the first and third month postoperatively with a high suspicion for the requirement of nutritional monitoring or other interventions.
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      References

        • Gianotti L.
        • Besselink M.G.
        • Sandini M.
        • et al.
        Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS).
        Surgery. 2018; 164: 1035-1048
        • Kanda M.
        • Fujii T.
        • Kodera Y.
        • Nagai S.
        • Takeda S.
        • Nakao A.
        Nutritional predictors of postoperative outcome in pancreatic cancer.
        Br J Surg. 2011; 98: 268-274
        • Probst P.
        • Fuchs J.
        • Schoen M.R.
        • et al.
        Nutritional risk in major abdominal surgery: NURIMAS Liver (DRKS00010923) - protocol of a prospective observational trial to evaluate the prognostic value of different nutritional scores in hepatic surgery.
        Int J Surg Protoc. 2017; 6: 5-10
        • Probst P.
        • Haller S.
        • Bruckner T.
        • et al.
        Prospective trial to evaluate the prognostic value of different nutritional assessment scores in pancreatic surgery (NURIMAS Pancreas).
        Br J Surg. 2017; 104: 1053-1062
        • Gilliland T.M.
        • Villafane-Ferriol N.
        • Shah K.P.
        • et al.
        Nutritional and metabolic derangements in pancreatic cancer and pancreatic resection.
        Nutrients. 2017; 9: 243
        • Pecorelli N.
        • Carrara G.
        • De Cobelli F.
        • et al.
        Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery.
        Br J Surg. 2016; 103: 434-442
        • Carrara G.
        • Pecorelli N.
        • De Cobelli F.
        • et al.
        Preoperative sarcopenia determinants in pancreatic cancer patients.
        Clin Nutr. 2017; 36: 1649-1653
        • Peng P.
        • Hyder O.
        • Firoozmand A.
        • et al.
        Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma.
        J Gastrointest Surg. 2012; 16: 1478-1486
        • Afaneh C.
        • Gerszberg D.
        • Slattery E.
        • Seres D.S.
        • Chabot J.A.
        • Kluger M.D.
        Pancreatic cancer surgery and nutrition management: a review of the current literature.
        Hepatobiliary Surg Nutr. 2015; 4: 59-71
        • Weimann A.
        • Braga M.
        • Carli F.
        • et al.
        ESPEN guideline: Clinical nutrition in surgery.
        Clin Nutr. 2017; 36: 623-650
        • Hendifar A.E.
        • Petzel M.Q.B.
        • Zimmers T.A.
        • et al.
        Pancreas cancer-associated weight loss.
        Oncologist. 2019; 24: 691-701
        • La Torre M.
        • Ziparo V.
        • Nigri G.
        • Cavallini M.
        • Balducci G.
        • Ramacciato G.
        Malnutrition and pancreatic surgery: prevalence and outcomes.
        J Surg Oncol. 2013; 107: 702-708
        • Kim H.
        • Yoon Y.S.
        • Han Y.
        • et al.
        Effects of pancreatic enzyme replacement therapy on body weight and nutritional assessments after pancreatoduodenectomy in a randomized trial.
        Clin Gastroenterol Hepatol. 2020; 18: 926-934
        • Gerritsen A.
        • Besselink M.G.
        • Gouma D.J.
        • Steenhagen E.
        • Borel Rinkes I.H.
        • Molenaar I.Q.
        Systematic review of five feeding routes after pancreatoduodenectomy.
        Br J Surg. 2013; 100 (discussion 599): 589-598
        • Gerritsen A.
        • Wennink R.A.
        • Besselink M.G.
        • et al.
        Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity.
        HPB (Oxford). 2014; 16: 656-664
        • Probst P.
        • Ohmann S.
        • Klaiber U.
        • et al.
        Meta-analysis of immunonutrition in major abdominal surgery.
        Br J Surg. 2017; 104: 1594-1608
        • Kang J.
        • Park J.S.
        • Yoon D.S.
        • et al.
        A study on the dietary intake and the nutritional status among the pancreatic cancer surgical patients.
        Clin Nutr Res. 2016; 5: 279-289
        • Mikamori M.
        • Miyamoto A.
        • Asaoka T.
        • et al.
        Postoperative changes in body composition after pancreaticoduodenectomy using multifrequency bioelectrical impedance analysis.
        J Gastrointest Surg. 2016; 20: 611-618
        • Huang J.J.
        • Yeo C.J.
        • Sohn T.A.
        • et al.
        Quality of life and outcomes after pancreaticoduodenectomy.
        Ann Surg. 2000; 231: 890-898
        • Carey S.
        • Storey D.
        • Biankin A.V.
        • Martin D.
        • Young J.
        • Allman-Farinelli M.
        Long term nutritional status and quality of life following major upper gastrointestinal surgery - a cross-sectional study.
        Clin Nutr. 2011; 30: 774-779
        • Thoresen L.
        • Frykholm G.
        • Lydersen S.
        • et al.
        The association of nutritional assessment criteria with health-related quality of life in patients with advanced colorectal carcinoma.
        Eur J Cancer Care (Engl). 2012; 21: 505-516
        • Kent T.S.
        • Sachs T.E.
        • Callery M.P.
        • Vollmer Jr., C.M.
        Readmission after major pancreatic resection: a necessary evil?.
        J Am Coll Surg. 2011; 213: 515-523
        • Vanounou T.
        • Pratt W.
        • Fisher J.E.
        • Vollmer Jr., C.M.
        • Callery M.P.
        Deviation-based cost modeling: a novel model to evaluate the clinical and exonomic impact of clinical pathways.
        J Am Coll Surg. 2007; 204: 570-579
        • Afshin A.
        • Forouzanfar M.H.
        • et al.
        • GBD 2015 Obersity Collaborators
        Health effects of overweight and obesity in 195 countries over 25 years.
        N Engl J Med. 2017; 377: 13-27
        • Peterson C.M.
        • Thomas D.M.
        • Blackburn G.L.
        • Heymsfield S.B.
        Universal equation for estimating ideal body weight and body weight at any BMI.
        Am J Clin Nutr. 2016; 103: 1197-1203
        • Bassi C.
        • Marchegiani G.
        • Dervenis C.
        • et al.
        and the International Study Group on Pancreatic Surgery (ISGPS). The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after.
        Surgery. 2017; 161: 584-591
        • Strasberg S.M.
        • Linehan D.C.
        • Hawkins W.G.
        The accordion severity grading system of surgical complications.
        Ann Surg. 2009; 250: 177-186
        • Niedergethmann M.
        • Shang E.
        • Farag Soliman M.
        • et al.
        Early and enduring nutritional and functional results of pylorus preservation vs classic Whipple procedure for pancreatic cancer.
        Langenbecks Arch Surg. 2006; 391: 195-202
        • Hashimoto D.
        • Chikamoto A.
        • Ohmuraya M.
        • et al.
        Impact of postoperative weight loss on survival after resection for pancreatic cancer.
        JPEN J Parenter Enteral Nutr. 2015; 39: 598-603
        • Schauer P.R.
        • Bhatt D.L.
        • Kirwan J.P.
        • et al.
        • and the STAMPEDE Investigators
        Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes.
        N Engl J Med. 2017; 376: 641-651
        • Davidson W.
        • Ash S.
        • Capra S.
        • Bauer J.
        • Cachexia Study Group
        Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer.
        Clin Nutr. 2004; 23: 239-247
        • Liu W.
        • Qdaisat A.
        • Lee E.
        • et al.
        The association between weight stability and parenteral nutrition characteristics and survival in patients with colorectal cancer.
        Gastroenterol Rep (Oxf). 2019; 7: 419-425
        • Higuera O.
        • Ghanem I.
        • Nasimi R.
        • Prieto I.
        • Koren L.
        • Feliu J.
        Management of pancreatic cancer in the elderly.
        World J Gastroenterol. 2016; 22: 764-775
        • Pratt W.B.
        • Gangavati A.
        • Agarwal K.
        • et al.
        Establishing standards of quality for elderly patients undergoing pancreatic resection.
        Arch Surg. 2009; 144: 950-956
        • Dalal S.
        • Hui D.
        • Bidaut L.
        • et al.
        Relationships among body mass index, longitudinal body composition alterations, and survival in patients with locally advanced pancreatic cancer receiving chemoradiation: a pilot study.
        J Pain Symptom Manage. 2012; 44: 181-191
        • Bachmann J.
        • Ketterer K.
        • Marsch C.
        • et al.
        Pancreatic cancer related cachexia: influence on metabolism and correlation to weight loss and pulmonary function.
        BMC Cancer. 2009; 9: 255
        • McMillan M.T.
        • Christein J.D.
        • Callery M.P.
        • et al.
        Comparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy.
        Surgery. 2016; 159: 1013-1022
        • Tee M.C.
        • Krajewski A.C.
        • Groeschl R.T.
        • et al.
        Indications and perioperative outcomes for pancreatectomy with arterial resection.
        J Am Coll Surg. 2018; 227: 255-269
        • Jegatheeswaran S.
        • Baltatzis M.
        • Jamdar S.
        • Siriwardena A.K.
        Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review.
        HPB (Oxford). 2017; 19: 483-490
        • Tosoian J.J.
        • Hicks C.W.
        • Cameron J.L.
        • et al.
        Tracking early readmission after pancreatectomy to index and nonindex institutions: a more accurate assessment of readmission.
        JAMA Surg. 2015; 150: 152-158
        • Wang P.
        • Li Y.
        • Sun H.
        • et al.
        Analysis of the associated factors for severe weight loss after minimally invasive McKeown esophagectomy.
        Thorac Cancer. 2019; 10: 209-218
        • Seykora T.F.
        • Ecker B.L.
        • McMillan M.T.
        • et al.
        • and the Pancreas Fistula Study Group
        The beneficial effects of minimizing blood loss in pancreatoduodenectomy.
        Ann Surg. 2019; 270: 147-157
        • Callery M.P.
        • Pratt W.B.
        • Kent T.S.
        • Chaikof E.L.
        • Vollmer Jr., C.M.
        A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy.
        J Am Coll Surg. 2013; 216: 1-14
        • Kubo H.
        • Komatsu S.
        • Ichikawa D.
        • et al.
        Impact of body weight loss on recurrence after curative gastrectomy for gastric cancer.
        Anticancer Res. 2016; 36: 807-813