Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

Table 1 Clinicopathologic characteristics of 52 patients undergoing total pancreatectomy

Variable	No. of patients
Mean age ± SD (yr)	60.3 ± 9.0
Sex (male)	32
Pathology
Adenocarcinoma	43
Cystadenocarcinoma	2
Invasive IPMN	4
Acinar adenocarcinoma	1
Adenosquamous carcinoma	1
Renal cell carcinoma metastasis	1
Tumor location
Head	28
Corpus	15
Tail	3
> 1 location	6
Median primary tumor size (IQR) (cm)	4.7 (3.0-6.0)
Venous invasion	26
Lymph node invasion	18
Splenectomy	11
Operative time (IQR) (min)	472.5 (421.3-548.8)
Operative arrangement
Planned	20
Unplanned	32
Postoperative complication1
Gastroplegia	4
Gastrointestinal or abdominal hemorrhage bleeding	1
Pneumonia	14
Abdominal infection	9
Hepatic failure	1
Respiratory failure	1
Length of postoperative hospital stay (IQR) (d)	12.0 (10.0-17.8)
Neoadjuvant treatment	14
Adjuvant treatment	52
Median recurrence-free time (IQR) (mo)	4.7 (2.7-13.6)
Median survival time (IQR) (mo)	20.9 (10.2-51.0)
1-year survival (%)	63.4
3-year survival (%)	24.2
5-year survival (%)	12.5

¹Five patients had two complications simultaneously, and one patient had three complications simultaneously. IPMN: Intraductal papillary mucinous neoplasms.

Table 2 Changes in biochemical data after total pancreatectomy

	Preop	Postop1	Postop 1 mo	Postop 3 mo	Postop 6 mo	Postop 12 mo	P value2
FBG (mg/dL)	130 ± 60	154 ± 39	153 ± 84	167 ± 94	149 ± 68	142 ± 79	0.078
HbA1c (%)	6.7 ± 1.5	/	6.7 ± 0.8	7.2 ± 1.0	6.8 ± 0.8	6.5 ± 0.8	0.330
BMI (kg/m2)	22.3 ± 3.2	/	21.2 ± 3.0	20.6 ± 2.8	20.3 ± 3.0	19.6 ± 2.5	0.001
Total protein (g/L)	65.7 ± 9.2	60.4 ± 6.6	68.4 ± 5.8	66.4 ± 4.9	67.2 ± 8.5	67.8 ± 6.3	0.369
Albumin (g/L)	39.3 ± 4.0	38.0 ± 4.2	38.2 ± 4.0	36.2 ± 4.4	38.0 ± 7.7	38.8 ± 4.6	0.933
Prealbumin (mg/L)	203.9 ± 54.3	171.6 ± 40.8	135.3 ± 34.6	147.9 ± 42.0	145.9 ± 48.8	148.2 ± 54.6	0.001
PNI	46.0 ± 3.4	47.8 ± 6.3	44.6 ± 4.0	43.8 ± 5.9	42.7 ± 5.9	47.3 ± 4.8	0.244

¹The postoperative data are mean values calculated from biochemical data in the first 3 d after surgery;

²Paired t-test, mean ± SD, Preop vs Postop 12 mo. FBG: Fasting blood glucose; BMI: Body mass index; PNI: Prognostic nutritional index; Postop: Postoperative.

Table 3 Factors for complications, recurrence-free and overall survival after total pancreatectomy

Variable	Multivariate analysis
	Odds ratio/hazard ratio	95%CI	P value
Complications
Postop FBG1
< 155 mg/dL
≥ 155 mg/dL	4.074	1.188-13.965	0.025
Postop prealbumin1
> 185 mg/L
≤ 185 mg/L	3.816	1.110-13.122	0.034
Recurrence-free survival
Preop FBG
≤ 110 mg/dL
> 110 mg/dL	2.330	1.204-4.510	0.012
Venous invasion
No
Yes	2.975	1.502-5.892	0.002
Postop HbA1c1
< 7%
≥ 7%	2.655	1.299-5.425	0.007
Postop PNI1
> 45
≤ 45	1.760	0.897-3.455	0.100
Overall survival
Diabetes mellitus
No
Short-term	0.943	0.300-2.965	0.920
Long-term	2.305	0.560-9.483	0.247
Preop FBG
≤ 110 mg/dL
> 110 mg/dL	1.112	0.357-3.462	0.854
Postop HbA1c2
< 7%
≥ 7%	3.212	1.147-8.999	0.026
Postop total protein2
> 55 g/L
≤ 55 g/L	1.152	0.304-4.364	0.835
Postop albumin2
> 35 g/L
≤ 35 g/L	2.894	0.551-15.195	0.209
Postop prealbumin2
> 185 mg/L
≤ 185 mg/L	3.961	0.976-16.068	0.054
Postop PNI2
> 45
≤ 45	1.143	0.242-5.408	0.866

¹Postoperative data were the latest biochemical values obtained during the last follow-up before tumor recurrence;

²Postoperative data were the latest biochemical values obtained during the last follow-up before patient death. FBG: Fasting blood glucose; PNI: Prognostic nutritional index.

Table 4 Preoperative factors for postoperative glycemic control and changes in body mass index after total pancreatectomy

Variable	Multivariate analysis
	Odds ratio/B	95%CI/SE	P value
Postoperative glycemic control1
Diabetes mellitus
No
Short-term	0.760	0.187-3.097	0.702
Long-term	15.019	1.278-176.211	0.031
Preop HbA1c
< 6.5%	1
≥ 6.5%	1.566	0.293-8.375	0.600
Changes in BMI1
Age (yr)	-1.010	0.733	0.175
Alcohol history, yes or no	1.985	0.860	0.025

¹Postoperative data were the latest biochemical values obtained during the last follow-up. BMI: Body mass index.