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Clinical significance of preoperative nutritional parameter and patient outcomes after pancreatectomy: A retrospective study at two academic institute
Ann Hepatobiliary Pancreat Surg 2019 May;23(2):168-73
Published online May 31, 2019;
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Atsushi Nanashima1,2, Masahide Hiyoshi1, Naoya Imamura1, Koichi Yano1, Takeomi Hamada1, Rouko Hamada1, Kenzo Nagatomo1, Makoto Ikenoue1, Shuichi Tobinaga2, Takeshi Nagayasu2

1Division of Hepato-Biliary-Pancreas Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, 2Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan
Received November 15, 2018; Revised December 14, 2018; Accepted December 15, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Preoperative nutritional status has been reported to influence patient outcomes after pancreatectomy. The Prognostic Nutritional Index (PNI) is a useful parameter to reflect the outcomes of patients undergoing gastrointestinal surgery. Therefore, the relationship between the PNI and clinicopathological factors, surgical data, and postoperative morbidity were retrospectively evaluated at two academic institutes in a cohort study.
Methods:Curative pancreatectomy was performed on 222 patients at the University of Nagasaki between 1995 and March 2015, and 101 at the University of Miyazaki between April 2015and March 2018. The PNI was calculated using preoperative albumin and total cholesterol levels.
Results: The mean PNI in our series was 39.2±5.4 and the prevalence of PNIs less than 40 was observed in 134 patients (44%). The PNI was not significantly different between normal, hard, and fatty architecture of the pancreatic parenchyma. The PNIs were significantly negatively correlated with higher age (p<0.01), but not with gender, co-morbidity, or habits. The PNI was significantly correlated with levels of hemoglobin, prothrombin activity, choline esterase, total protein, albumin and cholesterol (p<0.01), and with postoperative total protein and albumin levels (p<0.05). Although the preoperative PNI tended to be lower in patients with total postoperative complications, no significant differences for each complication were observed.
Conclusions: Although the preoperative PNIs reflect the perioperative nutritional status, its predictive usefulness for postoperative complications could not be significantly confirmed.
Keywords : Prognostic nutritional index; Pancreatectomy; Postoperative nutritional parameters; Postoperative complications