Surgery today · 2025
Significance of the nutritional and body composition status for predicting a postoperative Textbook Outcome after pancreaticoduodenectomy.
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Fukushima Ryosuke, Araki Kenichiro, Shoda Takahiro, Okuyama Takayuki, Seki Takaomi, Muranushi Ryo, Hoshino Kouki, Hagiwara Kei, Kawai Shunsuke, Tsukagoshi Mariko, Igarashi Takamichi, Kubo Norio, Shirabe Ken
Аннотация
PURPOSES: The Textbook Outcome (TBO) is a novel quality measure in pancreatic surgery, reflecting an ideal surgical outcome. This study aimed to identify the risk factors associated with achieving a TBO after pancreaticoduodenectomy.
METHODS: We retrospectively reviewed the records of 215 patients who underwent pancreaticoduodenectomy between 2016 and 2023. A TBO was defined as the absence of all six of the following parameters: 30-day mortality, readmission, postoperative pancreatic fistula, bile leakage, post-pancreatectomy hemorrhage, and severe complications (Clavien-Dindo grade ≥ III). Logistic regression was used to evaluate the impact of various factors, including nutritional status and body composition, on TBO achievement.
RESULTS: A TBO was achieved in 123 (57.2%) patients. There were no cases of 30-day mortality reported. A multivariate analysis identified age ≥ 75 years, a soft pancreas, malnutrition as assessed by the GLIM criteria, and a high visceral fat area/skeletal muscle area ratio (VFA/SMA ratio) as significant risk factors for not achieving a TBO. Additionally, patients who achieved a TBO had a significantly better overall survival than those who did not achieve a TBO.
CONCLUSIONS: This study underscores the importance of evaluating the nutritional status and body composition to improve surgical quality. Optimizing these factors preoperatively may support the achievement of a Textbook Outcome and improve the prognosis following pancreaticoduodenectomy.
METHODS: We retrospectively reviewed the records of 215 patients who underwent pancreaticoduodenectomy between 2016 and 2023. A TBO was defined as the absence of all six of the following parameters: 30-day mortality, readmission, postoperative pancreatic fistula, bile leakage, post-pancreatectomy hemorrhage, and severe complications (Clavien-Dindo grade ≥ III). Logistic regression was used to evaluate the impact of various factors, including nutritional status and body composition, on TBO achievement.
RESULTS: A TBO was achieved in 123 (57.2%) patients. There were no cases of 30-day mortality reported. A multivariate analysis identified age ≥ 75 years, a soft pancreas, malnutrition as assessed by the GLIM criteria, and a high visceral fat area/skeletal muscle area ratio (VFA/SMA ratio) as significant risk factors for not achieving a TBO. Additionally, patients who achieved a TBO had a significantly better overall survival than those who did not achieve a TBO.
CONCLUSIONS: This study underscores the importance of evaluating the nutritional status and body composition to improve surgical quality. Optimizing these factors preoperatively may support the achievement of a Textbook Outcome and improve the prognosis following pancreaticoduodenectomy.