Effect of prognostic nutritional index on clinically related postoperative pancreatic fistula after distal pancreatectomy and their related influencing factors_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Hao ^1,2 , WANG Feitong ² , WANG Cong ¹ , WEI Xin ² ,  LIU Bin ²

1. Xuzhou Medical University, Xuzhou, Jiangsu 221004, P. R. China;
2. Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, P. R. China;

Corresponding author：

LIU Bin, Email: xyfyzlwk@163.com

Keywords：

clinically related postoperative pancreatic fistula; distal pancreatectomy; prognostic nutritional index; influencing factor

DOI：

10.7507/1007-9424.202106001

Video：

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Objective To explore effect of preoperative prognostic nutritional index (PNI) on clinically related postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) and analyze its influencing factors in order to provide a basis for clinical prediction of CR-POPF. Methods The clinicopathologic data of patients who successfully completed DP in the Affiliated Hospital of Xuzhou Medical University and met the inclusion and exclusion criteria of this study from January 1, 2017 to January 31, 2021 were collected retrospectively. The preoperative PNI value was calculated and the optimal cut-off value was obtained according to the receiver operative characteristic (ROC) curve. The patients were divided into low and high PNI based on the optimal cut-off value. The clinicopathologic characteristics were compared between the patients with low and high PNI and CR-POPF or not. At the same time, multivariate logistic regression was used to analyze the influencing factors of CR-POPF. Results A total of 143 patients who met the inclusion and exclusion criteria were included in this study. The CR-POPF occurred in 33 cases (23.08%) after DP, and the average preoperative PNI was 52.26 (39.20–65.10), the optimal cut-off value of PNI was 50.55, with 49 cases in the low PNI group and 94 cases in the high PNI group. In patient with low PNI, the proportions of patients aged ≥65 years and with CR-POPF were higher than those with high PNI (P<0.05). In the patients with CR-POPF, the proportions of patients with soft pancreatic texture and with low preoperative PIN were higher than those without CR-POPF (P<0.05). Further, the multivariate logistic regression showed that the the preoperative low PNI (OR=5.417, P<0.001) and soft pancreatic texture (OR=4.126, P=0.002) increased the risk of CR-POPF. Conclusion Low preoperative PNI and soft pancreatic texture increase risk of CR-POPF after DP, and it is necessary to preoperatively evaluate PNI status of patients.

Citation： LI Hao, WANG Feitong, WANG Cong, WEI Xin, LIU Bin. Effect of prognostic nutritional index on clinically related postoperative pancreatic fistula after distal pancreatectomy and their related influencing factors. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(2): 211-217. doi: 10.7507/1007-9424.202106001 Copy

1.	赵平. 重视胰腺手术后胰瘘的预防. 中华普通外科杂志, 2009, 24(3): 177-178.
2.	Kanda M, Fujii T, Kodera Y, et al. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg, 2011, 98(2): 268-274.
3.	Sugimachi K, Iguchi T, Mano Y, et al. The impact of immunonutritional and physical status on surgical outcome after pancreaticoduodenectomy in elderly patients. Anticancer Res, 2019, 39(11): 6347-6353.
4.	梁荣朴, 叶林森, 张杰滨, 等. 术后预后营养指数在肝细胞癌患者预后中的价值. 中华肝脏外科手术学电子杂志, 2018, 7(2): 138-142.
5.	白雪莉, 沈艺南, 马涛, 等. 有关国际胰腺外科研究组术后胰瘘定义与分级系统(2016版)更新解读与探讨. 中国实用外科杂志, 2017, 37(3): 259-261.
6.	Hirashita T, Ohta M, Yada K, et al. Effect of pre-firing compression on the prevention of pancreatic fistula in distal pancreatectomy. Am J Surg, 2018, 216(3): 506-510.
7.	Sathianathen NJ, Kwaan M, Lawrentschuk N, et al. Adverse impact of malnutrition markers on major abdominopelvic cancer surgery. ANZ J Surg, 2019, 89(5): 509-514.
8.	Narendra K, Kiss N, Margerison C, et al. Impact of nutritional status/risk and post-operative nutritional management on clinical outcomes in patients undergoing gastrointestinal surgery: a prospective observational study. J Hum Nutr Diet, 2020, 33(4): 587-597.
9.	Kato Y, Yamada S, Suenaga M, et al. Impact of the controlling nutritional status score on the prognosis after curative resection of pancreatic ductal adenocarcinoma. Pancreas, 2018, 47(7): 823-829.
10.	Sierzega M, Niekowal B, Kulig J, et al. Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients. J Am Coll Surg, 2007, 205(1): 52-59.
11.	Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery. Am J Surg, 1980, 139(1): 160-167.
12.	孙开宇, 何裕隆. 胃肠道恶性肿瘤患者预后营养指数的研究进展. 消化肿瘤杂志(电子版), 2015, 7(2): 112-114.
13.	Sasahara M, Kanda M, Ito S, et al. The preoperative prognostic nutritional index predicts short-term and long-term outcomes of patients with stage Ⅱ/Ⅲ gastric cancer: analysis of a multi-institution dataset. Dig Surg, 2020, 37(2): 135-144.
14.	颜歆, 潘华, 彭宏伟. 倾向评分匹配法探讨预后营养指数与乳腺癌患者术后预后的关系. 中国肿瘤外科杂志, 2020, 12(5): 448-451.
15.	Liu N, Jiang A, Zheng X, et al. Prognostic nutritional index identifies risk of early progression and survival outcomes in advanced non-small cell lung cancer patients treated with PD-1 inhibitors. J Cancer, 2021, 12(10): 2960-2967.
16.	Xing H, Xiang D, Li Y, et al. Preoperative prognostic nutritional index predicts postoperative delirium in elderly patients after hip fracture surgery. Psychogeriatrics, 2020, 20(4): 487-494.
17.	杨加鹏, 张明杰, 陈建嘉, 等. 术前NLR、LMR、PNI值对胰十二指肠切除术后胰瘘发生的预测价值. 现代肿瘤医学, 2020, 28(22): 3926-3931.
18.	Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi, 1984, 85(9): 1001-1005.
19.	孔祥虎, 韩玮, 李秋影. 胰体尾切除术后胰瘘影响因素的多因素分析. 中国普外基础与临床杂志, 2020, 27(6): 708-713.
20.	Sato N, Mori Y, Minagawa N, et al. Rapid postoperative reduction in prognostic nutrition index is associated with the development of pancreatic fistula following distal pancreatectomy. Pancreatology, 2014, 14(3): 216-220.
21.	Sagar RC, Kumar KVV, Ramachandra C, et al. Perioperative artificial enteral nutrition in malnourished esophageal and stomach cancer patients and its impact on postoperative complications. Indian J Surg Oncol, 2019, 10(3): 460-464.
22.	Mazaki T, Ishii Y, Murai I. Immunoenhancing enteral and parenteral nutrition for gastrointestinal surgery: a multiple-treatments meta-analysis. Ann Surg, 2015, 261(4): 662-669.
23.	Wang GQ, Yadav DK, Jiang W, et al. Risk Factors for clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy: a single center retrospective study. Can J Gastroenterol Hepatol, 2021, 2021: 8874504. doi: 10.1155/2021/8874504.
24.	Hashimoto Y, Traverso LW. After distal pancreatectomy pancreatic leakage from the stump of the pancreas may be due to drain failure or pancreatic ductal back pressure. J Gastrointest Surg, 2012, 16(5): 993-1003.
25.	Hatano M, Watanabe J, Kushihata F, et al. Quantification of pancreatic stiffness on intraoperative ultrasound elastography and evaluation of its relationship with postoperative pancreatic fistula. Int Surg, 2015, 100(3): 497-502.
26.	岳钰峰, 黄子星, 田伯乐, 等. 胰十二指肠切除术后胰瘘风险预测的影像学研究进展. 中国普外基础与临床杂志, 2021, 28(1): 115-119.
27.	Ecker BL, McMillan MT, Allegrini V, et al. Risk factors and mitigation strategies for pancreatic fistula after distal pancrea tectomy: analysis of 2 026 resections from the international, multi-institutional distal pancreatectomy study group. Ann Surg, 2019, 269(1): 143-149.
28.	Miyamoto R, Sano N, Maeda M, et al. Modified reinforced staple closure technique decreases postoperative pancreatic fistula after distal pancreatectomy. Indian J Surg Oncol, 2019, 10(4): 587-593.

1. 赵平. 重视胰腺手术后胰瘘的预防. 中华普通外科杂志, 2009, 24(3): 177-178.
2. Kanda M, Fujii T, Kodera Y, et al. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg, 2011, 98(2): 268-274.
3. Sugimachi K, Iguchi T, Mano Y, et al. The impact of immunonutritional and physical status on surgical outcome after pancreaticoduodenectomy in elderly patients. Anticancer Res, 2019, 39(11): 6347-6353.
4. 梁荣朴, 叶林森, 张杰滨, 等. 术后预后营养指数在肝细胞癌患者预后中的价值. 中华肝脏外科手术学电子杂志, 2018, 7(2): 138-142.
5. 白雪莉, 沈艺南, 马涛, 等. 有关国际胰腺外科研究组术后胰瘘定义与分级系统(2016版)更新解读与探讨. 中国实用外科杂志, 2017, 37(3): 259-261.
6. Hirashita T, Ohta M, Yada K, et al. Effect of pre-firing compression on the prevention of pancreatic fistula in distal pancreatectomy. Am J Surg, 2018, 216(3): 506-510.
7. Sathianathen NJ, Kwaan M, Lawrentschuk N, et al. Adverse impact of malnutrition markers on major abdominopelvic cancer surgery. ANZ J Surg, 2019, 89(5): 509-514.
8. Narendra K, Kiss N, Margerison C, et al. Impact of nutritional status/risk and post-operative nutritional management on clinical outcomes in patients undergoing gastrointestinal surgery: a prospective observational study. J Hum Nutr Diet, 2020, 33(4): 587-597.
9. Kato Y, Yamada S, Suenaga M, et al. Impact of the controlling nutritional status score on the prognosis after curative resection of pancreatic ductal adenocarcinoma. Pancreas, 2018, 47(7): 823-829.
10. Sierzega M, Niekowal B, Kulig J, et al. Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients. J Am Coll Surg, 2007, 205(1): 52-59.
11. Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery. Am J Surg, 1980, 139(1): 160-167.
12. 孙开宇, 何裕隆. 胃肠道恶性肿瘤患者预后营养指数的研究进展. 消化肿瘤杂志(电子版), 2015, 7(2): 112-114.
13. Sasahara M, Kanda M, Ito S, et al. The preoperative prognostic nutritional index predicts short-term and long-term outcomes of patients with stage Ⅱ/Ⅲ gastric cancer: analysis of a multi-institution dataset. Dig Surg, 2020, 37(2): 135-144.
14. 颜歆, 潘华, 彭宏伟. 倾向评分匹配法探讨预后营养指数与乳腺癌患者术后预后的关系. 中国肿瘤外科杂志, 2020, 12(5): 448-451.
15. Liu N, Jiang A, Zheng X, et al. Prognostic nutritional index identifies risk of early progression and survival outcomes in advanced non-small cell lung cancer patients treated with PD-1 inhibitors. J Cancer, 2021, 12(10): 2960-2967.
16. Xing H, Xiang D, Li Y, et al. Preoperative prognostic nutritional index predicts postoperative delirium in elderly patients after hip fracture surgery. Psychogeriatrics, 2020, 20(4): 487-494.
17. 杨加鹏, 张明杰, 陈建嘉, 等. 术前NLR、LMR、PNI值对胰十二指肠切除术后胰瘘发生的预测价值. 现代肿瘤医学, 2020, 28(22): 3926-3931.
18. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi, 1984, 85(9): 1001-1005.
19. 孔祥虎, 韩玮, 李秋影. 胰体尾切除术后胰瘘影响因素的多因素分析. 中国普外基础与临床杂志, 2020, 27(6): 708-713.
20. Sato N, Mori Y, Minagawa N, et al. Rapid postoperative reduction in prognostic nutrition index is associated with the development of pancreatic fistula following distal pancreatectomy. Pancreatology, 2014, 14(3): 216-220.
21. Sagar RC, Kumar KVV, Ramachandra C, et al. Perioperative artificial enteral nutrition in malnourished esophageal and stomach cancer patients and its impact on postoperative complications. Indian J Surg Oncol, 2019, 10(3): 460-464.
22. Mazaki T, Ishii Y, Murai I. Immunoenhancing enteral and parenteral nutrition for gastrointestinal surgery: a multiple-treatments meta-analysis. Ann Surg, 2015, 261(4): 662-669.
23. Wang GQ, Yadav DK, Jiang W, et al. Risk Factors for clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy: a single center retrospective study. Can J Gastroenterol Hepatol, 2021, 2021: 8874504. doi: 10.1155/2021/8874504.
24. Hashimoto Y, Traverso LW. After distal pancreatectomy pancreatic leakage from the stump of the pancreas may be due to drain failure or pancreatic ductal back pressure. J Gastrointest Surg, 2012, 16(5): 993-1003.
25. Hatano M, Watanabe J, Kushihata F, et al. Quantification of pancreatic stiffness on intraoperative ultrasound elastography and evaluation of its relationship with postoperative pancreatic fistula. Int Surg, 2015, 100(3): 497-502.
26. 岳钰峰, 黄子星, 田伯乐, 等. 胰十二指肠切除术后胰瘘风险预测的影像学研究进展. 中国普外基础与临床杂志, 2021, 28(1): 115-119.
27. Ecker BL, McMillan MT, Allegrini V, et al. Risk factors and mitigation strategies for pancreatic fistula after distal pancrea tectomy: analysis of 2 026 resections from the international, multi-institutional distal pancreatectomy study group. Ann Surg, 2019, 269(1): 143-149.
28. Miyamoto R, Sano N, Maeda M, et al. Modified reinforced staple closure technique decreases postoperative pancreatic fistula after distal pancreatectomy. Indian J Surg Oncol, 2019, 10(4): 587-593.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of prognostic nutritional index on clinically related postoperative pancreatic fistula after distal pancreatectomy and their related influencing factors

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