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

AIM To evaluate the impact of glycemic control and nutritional status after total pancreatectomy(TP) on complications, tumor recurrence and overall survival.METHODS Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified.RESULTS High early postoperative fasting blood glucose(FBG) levels(OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels(OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative Hb A1 c levels over 7%(HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative Hb A1 c levels over 7% had much poorer overall survival than those with Hb A1 c levels less than 7%(9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus(HR = 15.019, 95%CI: 1.278-176.211, P= 0.031) and alcohol history(B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively.CONCLUSION At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on longterm outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.

Influence of cirrhosis in cardiac surgery outcomes

Liver cirrhosis has evolved an important risk factor for cardiac surgery due to the higher morbidity and mortality that these patients may suffer compared with general cardiac surgery population.The presence of contributing factors for a poor outcome,such as coagulopathy,a poor nutritional status,an adaptive immune dysfunction,a degree of cirrhotic cardiomyopathy,and a degree of renal and pulmonary dysfunction,have to be taken into account for surgical evaluation when cardiac surgery is needed,together with the degree of liver disease and its primary complications.The associated pathophysiological characteristics that liver cirrhosis represents have a great influence in the development of complications during cardiac surgery and the postoperative course.Despite the population of cirrhotic patients who are referred for cardiac surgery is small and recommendations come from small series,since liver cirrhotic patients have increased their chance of survival in the last 20 years due to the advances in their medical care,which includes liver transplantation,they have been increasingly considered for cardiac surgery.Indeed,there is an expected rise of cirrhotic patients within the cardiac surgical population due to the increasing rates of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis,especially in western countries.In consequence,a more specific approach is needed in the assessment of care of these patients if we want to improve their management.In this article,we review the pathophysiology and outcome prediction of cirrhotic patients who underwent cardiac surgery.