The Usefulness of Nutritional Index CONUT for Risk Assessment and Prognosis after Pancreaticoduodenectomy

C l i n M e d International Library Citation: Sekine S, Nagata T, Okumura T, Kawai S, Hirano K, et al. (2016) The Usefulness of Nutritional Index CONUT for Risk Assessment and Prognosis after Pancreaticoduodenectomy. Int J Cancer Clin Res 3:041 Received: December 20, 2015: Accepted: January 26, 2016: Published: January 28, 2016 Copyright: © 2016 Sekine S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Sekine et al. Int J Cancer Clin Res 2016, 3:041


Interpretation
Total score 0- of the TNM classification system of malignant tumors as published by UICC.
Complications that occurred within 60 days of surgery were recorded and graded according to the Clavier-Dindo classification [26].

Surgical site infection (SSI)
As defined by the CDC guidelines, SSI was identified when purulent discharges were observed within 30 days from any incision or intraoperatively manipulated space, with or without microbiological evidence of infection [24].

Pancreatic fistula and delayed gastric emptying
Pancreatic fistula and delayed gastric emptying was defined according to the International Study Group of Pancreatic Surgery (ISGPF) criteria [27][28][29][30].Statistical analyses were performed with using JMP software for Windows (SAS Institute Inc., Cary, NC, USA).To evaluate the relationship between each independent factor and presence of SSI and RI, univariate analysis was conducted using the χ 2 test.Prognostic factors were examined by both univariate and multivariate analyses.Evaluations were performed using the Kaplan-Meier method, and differences between survival curves were analyzed using the log-rank test.A p-value of < 0.05 was considered statistically significant.

Results
The analysis sample consisted of 116 consecutive cases that underwent PD.The average age was 69.7 years (range, 48-87 for determining the risk for post-operative complications.Factors such as gender, age, cause of disease, operative time, blood loss, and the presence of diabetes were also included.In malignant cases, the final stages of cancer were identified according to the seventh edition  and infectious complications.No significant differences in the operative characteristics were observed between patients with SSI and RI.Kaplan-Meier analysis revealed significantly less favorable overall survival rate rates in patients in low CONUT group than in the other groups (Log-rank test, p = 0.013).BMI was also associated with survival in univariate analysis (p = 0.018).There was no association between PNI and the prognosis (Table 5).Patients in the high CONUT sore and BMI < 18.5 group, had poorer prognosis compared with Low-CONUT score group (Figure 1).

Discussion
Evaluation of nutritional status may provide additional prognostic information for patients who are undergoing highly invasive surgery such as PD/PpPD.Post-operative infection is the most frequent complication following surgery.Post-operative surgical and medical complications are negative predictors for long-term malignancy outcomes.In this study, postoperative infection was one of the prognostic factors in univariate analysis.
Albumin level is a better predictor of some types of morbidity, particularly sepsis and major infections [31,32].However, because the albumin level is strongly affected by the body fluid volume and medical condition, it has poor reliability for nutritional status screening.The shorter half-life of albumin is a sensitive reflection of the nutritional status in real time.Nevertheless, the evaluation of the retinol binding protein (RBP), transferrin (Tf), and pre-albumin (PA).levels is often costly.As shown by Onodera et al.PNI is useful for the prediction and prognosis of post-operative complications.In table 2, PNI low value cases were significantly higher in the complication group.The average age of the complication group is also significantly high.For this reason, the elderly are considered to be due to included many complications group.
Table 4 shows the relationship between the clinical characteristics

Table 1 :
CONUT: a tool for controlling nutritional status.

Table 2 :
Number of patients undergoing pancreatoduodenectomy with complications

Table 4 :
Relationship between the clinical characteristics and infectious complications.

Table 5 :
Association between PNI and the prognosis.