Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2017; 23(2): 265-274
Published online Jan 14, 2017. doi: 10.3748/wjg.v23.i2.265
Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy
Hao-Jun Shi, Chen Jin, De-Liang Fu
Hao-Jun Shi, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, Shanghai 200040, China
Author contributions: Shi HJ contributed to the conception and design of the study, data acquisition, analysis and interpretation, drafting and revising of the article, and final approval of the version to be published; Jin C and Fu DL contributed to the conception and design of the study and final approval of it for publication.
Supported by National Natural Science Foundation of China, No. 81472221.
Institutional review board statement: The study was reviewed and approved by the Fudan University Huashan Hospital Ethical Committee and Institutional Review Board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: De-Liang Fu, MD, PhD, Professor, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, 12 Urumchi Middle Road, Shanghai 200040, China. surgeonf@126.com
Telephone: +86-21-52887164 Fax: +86-21-52888277
Received: October 28, 2016
Peer-review started: October 28, 2016
First decision: November 21, 2016
Revised: November 26, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: January 14, 2017
Processing time: 76 Days and 13.1 Hours
Abstract
AIM

To evaluate the impact of glycemic control and nutritional status after total pancreatectomy (TP) on complications, tumor recurrence and overall survival.

METHODS

Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified.

RESULTS

High early postoperative fasting blood glucose (FBG) levels (OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels (OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative HbA1c levels over 7% (HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative HbA1c levels over 7% had much poorer overall survival than those with HbA1c levels less than 7% (9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus (HR = 15.019, 95%CI: 1.278-176.211, P = 0.031) and alcohol history (B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively.

CONCLUSION

At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on long-term outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.

Keywords: Total pancreatectomy; Glycemic control; Nutritional status; Complication; Tumor recurrence; Prognosis

Core tip: Considering that total pancreatectomy (TP) deprives patients of endocrine and exocrine pancreatic function, the decision of TP in the setting of pancreatic tumors continues to be a challenge. A series of postoperative clinical parameters ensure the instantaneity of objective reflection of metabolism, and analyses of their association with outcomes may have more clinical value, compared with the preoperative ones. It is concluded that postoperative glycemic control and nutritional status have an impact on clinical outcomes after TP. Improvement in postoperative management is important to prevent early complications and tumor recurrence and, more importantly, improve survival.