Ann Hepatobiliary Pancreat Surg.  2019 Nov;23(4):372-376. 10.14701/ahbps.2019.23.4.372.

Clinical importance of preoperative and postoperative prognostic nutritional index in patients with pancreatic ductal adenocarcinoma

• Ikeguchi M
• Goto K
• Watanabe J
• Urushibara S
• Osaki T
• Endo K
• Tatebe S
• Nakamura S

• KMID: 2464327
• DOI: http://doi.org/10.14701/ahbps.2019.23.4.372

Abstract

BACKGROUNDS/AIMS
The prognostic nutritional index (PNI) is based on the albumin concentration and absolute lymphocyte count and is designed to assess the nutritional and immunological status of patients. In this study, we evaluated the prognostic importance of the preoperative and postoperative PNI in patients who underwent curative resection of pancreatic ductal adenocarcinoma (PDAC).
METHODS
From 2006 to 2017, 50 patients with PDAC underwent curative resection at our hospital. We performed distal pancreatectomy (DP) with splenectomy in 15 patients, pancreaticoduodenectomy (PD) in 27 patients, PD combined with portal vein partial resection in 6 patients, and total pancreatectomy with splenectomy in 2 patients. We compared the preoperative PNI and postoperative PNI (1 and 2 months postoperatively) and analyzed the prognostic importance for these patients.
RESULTS
The mean PNI significantly decreased from 45.5 preoperatively to 39.8 at 1 month postoperatively (p<0.001), but recovered to 42.7 at 2 months postoperatively. In 23 patients, the PNI at 2 months postoperatively recovered to the preoperative level (recovered group), but in the remaining 27 patients, the PNI at 2 months postoperatively did not reach the preoperative level (non-recovered group). The overall median survival time in the recovered group (29 months) was significantly longer than that in the non-recovered group (12 months, p=0.003). The multivariate overall analysis demonstrated that good recovery of the postoperative PNI was strongly correlated with a better prognosis.
CONCLUSIONS
Effective postoperative nutrition may have a prognostic benefit for patients with operable PDAC.

Keyword

Overall survival; Pancreatic ductal adenocarcinoma; Prognostic nutritional index

MeSH Terms

Adenocarcinoma*
Humans
Lymphocyte Count
Nutrition Assessment*
Pancreatectomy
Pancreatic Ducts*
Pancreaticoduodenectomy
Portal Vein
Prognosis
Splenectomy

Figure

• 

  Fig. 1 The mean prognostic nutritional index was 45.5 (range, 27.8–57.6) preoperatively, 39.8 (range, 14.0–57.2) at 1 month postoperatively, and 42.7 (range, 16.9–59.5) at 2 months postoperatively. *p<0.001, **p=0.002, ***p=0.045.

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  Fig. 2 Overall survival curves of 27 patients in the recovered group (solid line) and 23 patients in the non-recovered group (dotted line). The 5-year overall survival rate of patients in the non-recovered group (7.4%) was significantly lower than that of patients in the recovered group (24.3%, p=0.003).

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