Effects of Preoperative Malnutrition on Postoperative Surgical Outcomes and Quality of Life of Elderly Patients with Periampullary Neoplasms: A Single-Center Prospective Cohort Study

Abstract

Background/Aims: We investigated the effect of preoperative malnutrition on postoperative surgical outcomes in elderly patients undergoing pancreatoduodenectomy for periampullary neoplasms. Methods: This prospective cohort study enrolled 154 patients aged >= 65 years with periampullary neoplasms. Using the Mini Nutritional Assessment tool, patients were categorized into three groups according to their preoperative nutritional status: well-nourished (13.0%), at-risk-of-malnutrition (59.7%), and malnourished (27.3%). Results: Significant intergroup differences were observed in preoperative body mass index (25.6 +/- 2.4 kg/m(2) [well-nourished] vs 23.4 +/- 2.6 kg/m(2) [at-risk-of-malnutrition] vs 21.1 +/- 2.8 kg/m(2) [malnourished], p<0.001). The overall morbidity significantly differed between the well-nourished and malnourished groups (20% vs 50.0%, p=0.024). The rates of clinically significant postoperative pancreatic fistula were significantly different among groups (p=0.035). Univariate and multivariate analyses showed that the at-risk-of-malnutrition or malnourished status (hazard ratio [HR], 3.45; p=0.037) and intraoperative blood loss (HR, 1.01; p=0.040) significantly affected the overall postoperative morbidity in elderly patients. Conclusions: Before surgery, 87.0% of patients were classified into the at-risk-of-malnutrition or malnourished group. Compared with well-nourished patients, patients with nutritional issues showed a higher overall surgical morbidity. Improved preoperative nutritional status leads to favorable surgical outcomes in elderly patients.