Impactofpostoperativeglycemiccontrolandnutritionalstatusonclinicaloutcomesaftertotalpancreatectomy

摘要： AIMToevaluatetheimpactofglycemiccontrolandnutritionalstatusaftertotalpancreatectomy(TP)oncomplications,tumorrecurrenceandoverallsurvival.METHODSRetrospectiverecordsof52patientswithpancreatictumorswhounderwentTPwerecollectedfrom2007to2015.Aseriesofclinicalparameterscollectedbeforeandaftersurgery,andduringthefollow-upwereevaluated.Theassociationsofglycemiccontrolandnutritionalstatuswithcomplications,tumorrecurrenceandlong-termsurvivalweredetermined.Riskfactorsforpostoperativeglycemiccontrolandnutritionalstatuswereidentified.RESULTSHighearlypostoperativefastingbloodglucose(FBG)levels(OR=4.074,95%CI:1.188-13.965,P=0.025)andlowearlypostoperativeprealbuminlevels(OR=3.816,95%CI:1.110-13.122,P=0.034)weresignificantlyassociatedwithcomplicationsafterTP.PostoperativeHbA1clevelsover7%(HR=2.655,95%CI:1.299-5.425,P=0.007)wereidentifiedasoneoftheindependentriskfactorsfortumorrecurrence.PatientswithpostoperativeHbA1clevelsover7%hadmuchpooreroverallsurvivalthanthosewithHbA1clevelslessthan7%(9.3movs27.6mo,HR=3.212,95%CI:1.147-8.999,P=0.026).Patientswithlong-termdiabetesmellitus(HR=15.019,95%CI:1.278-176.211,P=0.031)andalcoholhistory(B=1.985,SE=0.860,P=0.025)tendedtohavepoorglycemiccontrolandlowerbodymassindexlevelsafterTP,respectively.CONCLUSIONAtleast3moarerequiredafterTPtoadapttodiabetesandrecovernutritionalstatus.GlycemiccontrolappearstohavemoreinfluenceovernutritionalstatusonlongtermoutcomesafterTP.ImprovementinglycemiccontrolandnutritionalstatusafterTPisimportanttopreventearlycomplicationsandtumorrecurrence,andimprovesurvival. ... （共10页）