Effects of sarcopenia and malnutrition on short-term prognosis after minimally invasive pancreaticoduodenectomy

Abstract

Bcakground Minimally invasive pancreaticoduodenectomy (MIPD) has been routinely performed in major centers, and its feasibility and efficacy in tumor treatment have been highly recognized. However, the resection process of MIPD is still complicated with postoperative morbidities. The effect of sarcopenia and malnutritional status on postoperative clinical outcomes still remains unclear and controversial. Methods The clinical data of 207 patients who had consecutively received MIPD between June 2017 and December 2022 were retrospectively analyzed. A multidimensional nutritional assessment was performed before surgery. Multivariate analysis and propensity score– matched (PSM) procedure was performed to identify the effects of sarcopenia and preoperative nutritional status on postoperative short-term prognosis. Results In the multivariable analysis, sarcopenia (OR 9.742, 95% CI 3.339–43.025, p = 0.002) was affected postoperative morbidity/mortality, weight Loss % (MD 0.486, 95% CI 0.188–0.784, p = 0.007) and operation time (MD 0.016, 95% CI 0.003–0.029, p = 0.0) were associated with length of hospital stay. Sarcopenia was identified as an independent, prognostic factor for postoperative pancreatic fistulas (POPFs) (OR 8.499, 95% CI 2.558–40.178, p = 0.008) and Clavien Score III IV V (OR 15.211, 95% CI 4.679–71.295, p < 0.001). Conclusion Sarcopenia before MIPD can affect postoperative outcomes, especially POPFs. Sarcopenia and nutritional status assessment should be part of routine preoperative procedures to provide early and appropriate nutritional support for prospective MIPD patients.