Pylorus‐preserving versus Pylorus‐resecting: Impact on dynamic changes of nutrition and body composition in pancreatic cancer patients before and after pancreatoduodenectomy

Abstract

Objectives To investigate if different methods of pancreatoduodenectomy (with or without pyloric preservation) would have different impacts on postoperative nutrition and body composition changes among pancreatic cancer patients. Methods Demographic and clinicopathological data, perioperative data were collected, body composition (e.g. skeletal muscle cross‐sectional area [CSA], visceral fat area [VFA]) were evaluated with abdominal CT before and after surgery. Sarcopenia patients' proportion changes were also recorded. Results The hospital stay in the PRPD group was significantly less than that in the PPPD group ( p < 0.05). A significant difference was found in CSA, skeletal muscle index (SMI), VFA, VFA/CSA and albumin (ALB) in both groups between preoperative, 3, and 12 months after surgery. The loss of visceral fat in the PRPD group was more prominent than that in the PPPD group at 3 months and 12 months after surgery ( p < 0.05). VFA/CSA was higher in the PPPD group than in the PRPD group (3 months: p < 0.05, 12 months: p < 0.001). The proportion of sarcopenic patients increased significantly over time in the PPPD and PRPD groups ( p < 0.001). Conclusions Postoperative CSA and VFA continued to significantly decrease in both PPPD and PRPD groups, while the incidence of sarcopenia continued to increase. Compared with PRPD, PPPD has a protective effect on visceral fat. PPPD may contribute to better maintaining visceral fat mass and blood ALB levels. CT quantification can be an objective and effective method to evaluate the nutritional status of pancreatic cancer patients during the pre‐ and postoperative period and can provide a useful objective basis for guiding clinical treatment.

Bibliometric analysis of research trends in relationship between sarcopenia and surgery

“…A multi-center study conducted in the USA showed that sarcopenia is more prevalent in patients with inflammatory bowel disease undergoing surgery, while the clinical nutrition markers including the body mass index and albumin were similar in the population (33). It is also reported that patients who underwent different methods of pancreatoduodenectomy may also have different changes in skeletal muscle cross-sectional area and visceral fat area, and the incidence of sarcopenia in both surgical procedures continued to increase (34). Many studies paid more attention to the role of nutrition in sarcopenia and surgery (35)(36)(37).…”