Value of geriatric nutritional risk index in predicting postoperative complications after pancreaticoduodenectomy in the elderly_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Bolin , Atigu·Abuduwaili , SU Hongde , GENG Cheng ,  XU Xinjian

Department of Hepatobiliary and Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University (The Fifth Clinical Medical College of Xinjiang Medical University), Urumqi 830011, P. R. China;

Corresponding author：

XU Xinjian, Email: xxj0991@163.com

Keywords：

geriatric nutritional risk index; pancreatic cancer; pancreaticoduodenectomy; postoperative complications; severe complications

DOI：

10.7507/1007-9424.202407098

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the predictive value of the geriatric nutritional risk index (GNRI) for postoperative overall and severe complications after pancreaticoduodenectomy (PD) in the elderly patients with pancreatic cancer. Methods The clinical data of the elderly (65 years old or more) patients with pancreatic cancer underwent PD were retrospectively collected, who were admitted to the Department of Hepatobiliary and Pancreatic Surgery, the Fifth Affiliated Hospital of Xinjiang Medical University from January 2017 to October 2021. The incidences of postoperative overall and severe complications (Clavien-Dindo grade Ⅲ–Ⅴ was defined as severe complications) were summarized. The univariate and multivariate logistic regression models were used to analyze whether GNRI was a risk factor for overall and severe complications after PD. The area under the receiver operating characteristic curve (AUC) was used to evaluate the ability of GNRI to distinguish whether overall or severe complications occurred after PD and to confirm the optimal threshold. Then the patients were assigned into a high nutritional risk group (greater than the optimal threshold) and low nutritional risk group (the optimal threshold or less) based on this. Simultaneously, the clinical outcomes of the two groups were compared. Results In this study, 190 elderly patients with pancreatic cancer were enrolled, 95(50.0%) of whom developed complications, including 28(29.5%) cases of serious complications. The results of multivariate logistic regression model analysis showed that the decreased GNRI was a risk factor for the occurrence of overall and severe complications after PD for the elderly patients [OR(95%CI)=0.195(0.065, 0.592), P=0.004; OR(95%CI)=0.890(0.823, 0.906), P=0.003]. The AUC of GNRI for assessing the occurrence of overall and severe complications was 0.765 and 0.715, respectively, with the optimal critical values of 98 and 96, respectively. Compared with the low nutritional risk group, the high nutritional risk group had higher postoperative total hospitalization costs (Z=–2.49, P=0.013), higher occurrences of overall complications (χ²=44.609, P<0.001) and severe complications (χ²=7.889, P=0.005), and higher occurrences of pancreatic fistula and gastric emptying disorders (χ²=17.682, P<0.001; χ²=4.975, P=0.026). Conclusions In elderly patients with pancreatic cancer underwent PD, incidence of serious complications is not lower. GNRI has a good discriminative value in terms of postoperative overall and severe complications. When preoperative GNRI is 98 or less and GNRI is 96 or less, patients should be given early preoperative nutritional support treatment in time.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 2024, 31(7): 769-780.
3.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 2020, 70(1): 7-30.
4.	Pezzilli R, Caccialanza R, Capurso G, et al. Pancreatic enzyme replacement therapy in pancreatic cancer. Cancers (Basel), 2020, 12(2): 275. doi: 10.3390/cancers12020275.
5.	Yu K, Zhou XR, He SL. A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with cancer. Eur J Clin Nutr, 2013, 67(7): 732-737.
6.	Petzel MQB, Hoffman L. Nutrition implications for long-term survivors of pancreatic cancer surgery. Nutr Clin Pract, 2017, 32(5): 588-598.
7.	Lin J, Peng J, Qdaisat A, et al. Severe weight loss during preoperative chemoradiotherapy compromises survival outcome for patients with locally advanced rectal cancer. J Cancer Res Clin Oncol, 2016, 142(12): 2551-2560.
8.	Hill A, Kiss N, Hodgson B, et al. Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients. Clin Nutr, 2011, 30(1): 92-98.
9.	Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr, 2005, 82(4): 777-783.
10.	Cereda E, Zagami A, Vanotti A, et al. Geriatric Nutritional Risk Index and overall-cause mortality prediction in institutionalised elderly: a 3-year survival analysis. Clin Nutr, 2008, 27(5): 717-723.
11.	Tsukagoshi M, Araki K, Igarashi T, et al. Lower geriatric nutritional risk index and prognostic nutritional index predict postoperative prognosis in patients with hepatocellular carcinoma. Nutrients, 2024, 16(7): 940. doi: 10.3390/nu16070940.
12.	张俊萍, 王奕妍, 庄绯菲, 等. 老年营养风险指数联合前清蛋白对老年肝癌患者术后并发症的预测价值. 国际医药卫生导报, 2023, 29(1): 83-86.
13.	Kang HW, Seo SP, Kim WT, et al. Prognostic impact of nutritional status assessed by the controlling nutritional status (CONUT) score in patients with surgically treated renal cell carcinoma. Nutr Cancer, 2018, 70(6): 886-894.
14.	Kim WS, Choi DW, Choi SH, et al. Clinical validation of the ISGPF classification and the risk factors of pancreatic fistula formation following duct-to-mucosa pancreaticojejunostomy by one surgeon at a single center. J Gastrointest Surg, 2011, 15(12): 2187-2192.
15.	Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
16.	姜翀弋, 马明剑, 王巍. 胰腺手术后出血的治疗决策. 肝胆外科杂志, 2021, 29(4): 254-256,261.
17.	张太平. 胰腺术后外科常见并发症诊治及预防的专家共识(2017)推荐. 协和医学杂志, 2017, 8(Z1): 146.
18.	刘远赫, 孙备, 陈华. 中华医学会胰腺术后外科常见并发症诊治及预防的专家共识(2017)解读. 临床外科杂志, 2017, 25(10): 725-727.
19.	Funamizu N, Nakabayashi Y, Kurihara K. Lower geriatric nutritional risk index predicts postoperative pancreatic fistula in patients with distal pancreatectomy. Mol Clin Oncol, 2020, 12(2): 134-137.
20.	张敬柱, 杨洁, 李刚, 等. 胰腺坏死组织感染并发十二指肠瘘诊治及预后研究. 中国实用外科杂志, 2021, 41(3): 315-319.
21.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
22.	Sahora K, Morales-Oyarvide V, Thayer SP, et al. The effect of antecolic versus retrocolic reconstruction on delayed gastric emptying after classic non-pylorus-preserving pancreaticoduodenectomy. Am J Surg, 2015, 209(6): 1028-1035.
23.	吴浩然, 张恒, 段小辉, 等. 腹腔镜胰十二指肠切除术后并发症发生的危险因素分析及术后胰瘘风险预测模型的建立. 中华普通外科杂志, 2020, 35(11): 838-842.
24.	刘翔, 王博, 吴汉青, 等. 胰十二指肠切除术后早期并发症的危险因素分析. 中华普通外科杂志, 2011, 26(12): 1008-1011.
25.	孙建军, 陈敏胜. 影响胰十二指肠切除术后早期并发症的危险因素分析. 中国医师进修杂志, 2012, 35(5): 24-27.
26.	Winter JM, Cameron JL, Yeo CJ, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg, 2007, 204(5): 1029-1038.
27.	Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp, 2005, 20(1): 38-45.
28.	Utsumi M, Aoki H, Nagahisa S, et al. Preoperative predictive factors of pancreatic fistula after pancreaticoduodenectomy: usefulness of the CONUT score. Ann Surg Treat Res, 2020, 99(1): 18-25.
29.	Utsumi M, Aoki H, Nagahisa S, et al. Preoperative nutritional assessment using the controlling nutritional status score to predict pancreatic fistula after pancreaticoduodenectomy. In Vivo, 2020, 34(4): 1931-1939.
30.	Shiihara M, Higuchi R, Izumo W, et al. Impact of the controlling nutritional status score on severe postoperative complications of pancreaticoduodenectomy for pancreatic cancer. Langenbecks Arch Surg, 2021, 406(5): 1491-1498.
31.	Kato Y, Yamada S, Suenaga M, et al. lmpact of the controlling nutritional status score on the prognosis after curative resection of pancreatic ductal adenocarcinoma. Pancreas, 2018, 47: 823-829.
32.	Terasaki F, Sugiura T, Okamura Y, et al. The preoperative controlling nutritional status (CONUT) score is an independent prognostic marker for pancreatic ductal adenocarcinoma. Updates Surg, 2021, 73(1): 251-259.
33.	Terasaki F, Sugiura T, Okamura Y, et al. Use of preoperative controlling nutritional status (CONUT) score as a better prognostic marker for distal cholangiocarcinoma after pancreatoduodenectomy. Surg Today, 2021, 51(3): 358-365.
34.	Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, Part Ⅱ: Laboratory evaluation. Nutrition, 2000, 16(2): 131-140.
35.	Stephensen CB. Examining the effect of a nutrition intervention on immune function in healthy humans: what do we mean by immune function and who is really healthy anyway? Am J Clin Nutr, 2001, 74(5): 565-566.
36.	Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr, 2005, 82(4): 777-783.
37.	Funamizu N, Nakabayashi Y, Iida T, et al. Geriatric nutritional risk index predicts surgical site infection after pancreaticoduodenectomy. Mol Clin Oncol, 2018, 9(3): 274-278.
38.	Hou TY, Lin YH, Liu YW, et al. The impact of preoperative nutritional status on postoperative outcomes: an insight from Geriatric Nutritional Risk Index in elderly pancreaticoduodenectomy patients. BMC Surg, 2024, 24(1): 100. doi: 10.1186/s12893-024-02397-0.
39.	Kitagawa Y, Kawabata Y, Fujishiro K, et al. Postoperative nutritional evaluation using geriatric nutritional risk index (GNRI) for aged patients with pancreatocoduodenectomy. J Geriatr Oncol, 2014, 5(Suppl 1): S12-S13. doi: 10.1016/j.jgo.2014.06.029.
40.	Ying J, Zhu S, Cheng Y, et al. Prognostic role of hemoglobin combined with geriatric nutritional risk index in patients with vater ampulla carcinoma undergoing pancreaticoduodenectomy. Cancer Med, 2024, 13(19): e70334. doi: 10.1002/cam4.70334.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 2024, 31(7): 769-780.
3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 2020, 70(1): 7-30.
4. Pezzilli R, Caccialanza R, Capurso G, et al. Pancreatic enzyme replacement therapy in pancreatic cancer. Cancers (Basel), 2020, 12(2): 275. doi: 10.3390/cancers12020275.
5. Yu K, Zhou XR, He SL. A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with cancer. Eur J Clin Nutr, 2013, 67(7): 732-737.
6. Petzel MQB, Hoffman L. Nutrition implications for long-term survivors of pancreatic cancer surgery. Nutr Clin Pract, 2017, 32(5): 588-598.
7. Lin J, Peng J, Qdaisat A, et al. Severe weight loss during preoperative chemoradiotherapy compromises survival outcome for patients with locally advanced rectal cancer. J Cancer Res Clin Oncol, 2016, 142(12): 2551-2560.
8. Hill A, Kiss N, Hodgson B, et al. Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients. Clin Nutr, 2011, 30(1): 92-98.
9. Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr, 2005, 82(4): 777-783.
10. Cereda E, Zagami A, Vanotti A, et al. Geriatric Nutritional Risk Index and overall-cause mortality prediction in institutionalised elderly: a 3-year survival analysis. Clin Nutr, 2008, 27(5): 717-723.
11. Tsukagoshi M, Araki K, Igarashi T, et al. Lower geriatric nutritional risk index and prognostic nutritional index predict postoperative prognosis in patients with hepatocellular carcinoma. Nutrients, 2024, 16(7): 940. doi: 10.3390/nu16070940.
12. 张俊萍, 王奕妍, 庄绯菲, 等. 老年营养风险指数联合前清蛋白对老年肝癌患者术后并发症的预测价值. 国际医药卫生导报, 2023, 29(1): 83-86.
13. Kang HW, Seo SP, Kim WT, et al. Prognostic impact of nutritional status assessed by the controlling nutritional status (CONUT) score in patients with surgically treated renal cell carcinoma. Nutr Cancer, 2018, 70(6): 886-894.
14. Kim WS, Choi DW, Choi SH, et al. Clinical validation of the ISGPF classification and the risk factors of pancreatic fistula formation following duct-to-mucosa pancreaticojejunostomy by one surgeon at a single center. J Gastrointest Surg, 2011, 15(12): 2187-2192.
15. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
16. 姜翀弋, 马明剑, 王巍. 胰腺手术后出血的治疗决策. 肝胆外科杂志, 2021, 29(4): 254-256,261.
17. 张太平. 胰腺术后外科常见并发症诊治及预防的专家共识(2017)推荐. 协和医学杂志, 2017, 8(Z1): 146.
18. 刘远赫, 孙备, 陈华. 中华医学会胰腺术后外科常见并发症诊治及预防的专家共识(2017)解读. 临床外科杂志, 2017, 25(10): 725-727.
19. Funamizu N, Nakabayashi Y, Kurihara K. Lower geriatric nutritional risk index predicts postoperative pancreatic fistula in patients with distal pancreatectomy. Mol Clin Oncol, 2020, 12(2): 134-137.
20. 张敬柱, 杨洁, 李刚, 等. 胰腺坏死组织感染并发十二指肠瘘诊治及预后研究. 中国实用外科杂志, 2021, 41(3): 315-319.
21. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
22. Sahora K, Morales-Oyarvide V, Thayer SP, et al. The effect of antecolic versus retrocolic reconstruction on delayed gastric emptying after classic non-pylorus-preserving pancreaticoduodenectomy. Am J Surg, 2015, 209(6): 1028-1035.
23. 吴浩然, 张恒, 段小辉, 等. 腹腔镜胰十二指肠切除术后并发症发生的危险因素分析及术后胰瘘风险预测模型的建立. 中华普通外科杂志, 2020, 35(11): 838-842.
24. 刘翔, 王博, 吴汉青, 等. 胰十二指肠切除术后早期并发症的危险因素分析. 中华普通外科杂志, 2011, 26(12): 1008-1011.
25. 孙建军, 陈敏胜. 影响胰十二指肠切除术后早期并发症的危险因素分析. 中国医师进修杂志, 2012, 35(5): 24-27.
26. Winter JM, Cameron JL, Yeo CJ, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg, 2007, 204(5): 1029-1038.
27. Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp, 2005, 20(1): 38-45.
28. Utsumi M, Aoki H, Nagahisa S, et al. Preoperative predictive factors of pancreatic fistula after pancreaticoduodenectomy: usefulness of the CONUT score. Ann Surg Treat Res, 2020, 99(1): 18-25.
29. Utsumi M, Aoki H, Nagahisa S, et al. Preoperative nutritional assessment using the controlling nutritional status score to predict pancreatic fistula after pancreaticoduodenectomy. In Vivo, 2020, 34(4): 1931-1939.
30. Shiihara M, Higuchi R, Izumo W, et al. Impact of the controlling nutritional status score on severe postoperative complications of pancreaticoduodenectomy for pancreatic cancer. Langenbecks Arch Surg, 2021, 406(5): 1491-1498.
31. Kato Y, Yamada S, Suenaga M, et al. lmpact of the controlling nutritional status score on the prognosis after curative resection of pancreatic ductal adenocarcinoma. Pancreas, 2018, 47: 823-829.
32. Terasaki F, Sugiura T, Okamura Y, et al. The preoperative controlling nutritional status (CONUT) score is an independent prognostic marker for pancreatic ductal adenocarcinoma. Updates Surg, 2021, 73(1): 251-259.
33. Terasaki F, Sugiura T, Okamura Y, et al. Use of preoperative controlling nutritional status (CONUT) score as a better prognostic marker for distal cholangiocarcinoma after pancreatoduodenectomy. Surg Today, 2021, 51(3): 358-365.
34. Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, Part Ⅱ: Laboratory evaluation. Nutrition, 2000, 16(2): 131-140.
35. Stephensen CB. Examining the effect of a nutrition intervention on immune function in healthy humans: what do we mean by immune function and who is really healthy anyway? Am J Clin Nutr, 2001, 74(5): 565-566.
36. Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr, 2005, 82(4): 777-783.
37. Funamizu N, Nakabayashi Y, Iida T, et al. Geriatric nutritional risk index predicts surgical site infection after pancreaticoduodenectomy. Mol Clin Oncol, 2018, 9(3): 274-278.
38. Hou TY, Lin YH, Liu YW, et al. The impact of preoperative nutritional status on postoperative outcomes: an insight from Geriatric Nutritional Risk Index in elderly pancreaticoduodenectomy patients. BMC Surg, 2024, 24(1): 100. doi: 10.1186/s12893-024-02397-0.
39. Kitagawa Y, Kawabata Y, Fujishiro K, et al. Postoperative nutritional evaluation using geriatric nutritional risk index (GNRI) for aged patients with pancreatocoduodenectomy. J Geriatr Oncol, 2014, 5(Suppl 1): S12-S13. doi: 10.1016/j.jgo.2014.06.029.
40. Ying J, Zhu S, Cheng Y, et al. Prognostic role of hemoglobin combined with geriatric nutritional risk index in patients with vater ampulla carcinoma undergoing pancreaticoduodenectomy. Cancer Med, 2024, 13(19): e70334. doi: 10.1002/cam4.70334.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesValue of geriatric nutritional risk index in predicting postoperative complications after pancreaticoduodenectomy in the elderly

Abstract Full text Figures/Tables Video References Cited by

Format

Content