Postoperative pancreatic fistula (POPF) is the most important factor affecting morbidity and mortality after pancreaticoduodenectomy (PD). Patients with a high controlling nutritional status (CONUT) score, which is used to assess nutritional status, are expected to have high morbidity rates. This study aimed to determine the usefulness of the CONUT score. Methods: Data from 97 consecutive cases of PD performed in the Department of Surgery of Iwakuni Clinical Center, from April 2008 to May 2018, were included. Preoperative patient data, including sex, age, and hypertension, and postoperative complication data were collected to analyze pancreatic fistula occurrence. Results: Of the 97 patients, 2 9 patients (29.8%) were diagnosed with POPF ≥ B, with 26 cases (26.8%) classified as grade B and 3 (3.1%) as grade C. The mortality rate was 2.1% (2 of 97). In the univariate analysis, a significant association was observed between POPF and the following factors: body mass index (BMI) ≥ 22 kg/m 2 , high CONUT score, nonpancreatic carcinoma, and CT attenuation values. In multivariate analysis, BMI ≥ 22 kg/m 2 (odds ratio [OR], 6.16; P < 0.001), high CONUT score (OR, 3.77; P = 0.009), nonpancreatic carcinoma (OR, 5.72; P = 0.009), and CT attenuation values (late/early ratio) in the pancreas (OR, 9.07; P = 0.006) were independent risk factors for POPF. Conclusion: Patients with a high CONUT score are at high risk of POPF. Further study correlating preoperative nutritional intervention with risk of POPF is necessary.

Background Con icting data on the safety of pancreaticoduodenectomy (PD) for elderly patients exist. Therefore, this study aimed to evaluate and compare the nutritional factors and clinical outcomes of PD between elderly and non-elderly patients. Methods A retrospective study of 122 consecutive patients who underwent PD from April 2008 to April 2020 was conducted. Preoperative and postoperative nutritional factors (prognostic nutritional index [PNI]), complication rates, and survival rates were compared between the elderly (age ≥80 years) and non-elderly (age <80 years) patient groups. Furthermore, changes in nutrition markers were evaluated before surgery to 1 year after surgery. Data were analyzed using unpaired Student's t-test, chi-squared test with Fisher's exact test, and log-rank test. Results A total of 20 elderly patients (16.4%) and 102 non-elderly patients (83.6%) underwent PD. With respect to preoperative factors, elderly patients had a signi cantly lower PNI than non-elderly patients. The duration of operation, amount of blood loss, postoperative complication rate, and incidence rate of pancreatic stula were similar between the two groups. At 3 months postoperatively, elderly patients had a lower albumin level and PNI than non-elderly patients. The median length of hospital stay was signi cantly longer in the elderly group than in the non-elderly group (39.9 vs. 27 days, P=0.004). The rate of death due to other diseases was relatively higher in the elderly group than in the non-elderly group. Elderly patients had a signi cantly lower overall survival rate than non-elderly patients (1-/3-/5-year overall survival rates: 78.1%/26.7%/13.3% vs. 87.1%/54.4%/46.7%; log-rank test, P=0.008). Conclusions Elderly patients had a lower nutritional status and lower survival rate than non-elderly patients. Careful patient selection and optimal perioperative care are necessary to determine whether PD is indicated for elderly patients.

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Thepatientwasa63-year-oldmanwhohadbeenfollowedupfordiffuselargeB-celllymphoma.A PET-CTscanshowedabnormalFDGuptakeinthesigmoidcolon.Acolonoscopyrevealedsigmoidcolon cancer. A preoperative contrast-enhanced CT scan showed the colonic tumor invading the abdominal wall and obstruction of the lower aorta suggesting association of Leriche syndrome. We expected that bloodwassuppliedtothelowerextremitiesandpelvicorgansviacollateralcirculationintheabdominal wallandthetrunk.Byproceedingwithsurgicaloperationwhileevaluatingthebloodflowbeforeandduringsurgery,sigmoidectomywithabdominalwallresectionwasperformedsafelywithoutrevascularization. Hewasdischarged13daysafterthesurgeryuneventfully.