J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 15, Number 6, June 2023, pages 300-309

Preoperative Risk Factors in Patients With Pancreatic Cancer

Figure 2. Postoperative complications contents. The number of complications (%) of all pancreatic cancer patients included in the study is indicated.

Figure 3. ROC curves generated by the factors of (a) age, (b) preoperative fat mass, (c) fat mass change rate, and (d) walking speed in the group with postoperative complications. AUC: area under the ROC curve; CI: confidence interval.

**Table 1.** Patient Characteristics in the Two Study Groups
	No complications (n = 14)	Complications (n = 45)	P value
ASA-PS: American Society of Anesthesiologists - Physical Status; CONUT: controlling nutrition status; PNI: prognostic nutritional index; PD: pancreatoduodenectomy; DP: distal pancreatectomy; TP: total pancreatectomy.
ASA-PS (%)
1	1 (7.1)	2 (4.4)	0.23
2	12 (85.7)	30 (66.7)
3	1 (7.1)	13 (28.9)
Surgical technique
DP	4 (28.6)	25 (55.6)	0.11
PD	10 (71.4)	18 (40.0)
TP	0 (0.0)	2 (4.4)
Sex
Men	5 (35.7)	20 (44.4)	0.75
Women	9 (64.3)	25 (55.6)
Age	67.5 (54 - 78)	74.0 (44 - 88)	0.02
Preoperative CONUT score
≤ 4	14 (100.0)	39 (86.7)	0.31
≥ 5	0 (0.0)	6 (13.3)
Preoperative PNI
< 40	0 (0.0)	4 (8.9)	0.56
> 40	14 (100.0)	41 (91.1)
Anesthesia time (h)	10.45 (6.7 - 14.8)	8.6 (3.5 - 14.9)	0.47
Operation time (h)	9.2 (5.5 - 13.6)	7.6 (2.5 - 13.6)	0.58
Infusion volume (mL)	2,725 (1,550 - 5,950)	2,500 (850 - 2,950)	0.72
Blood transfusion
No	6 (42.9)	28 (62.2)	0.22
Yes	8 (57.1)	17 (37.8)
Urine output (mL)	385 (50 - 1,280)	302 (80 - 1,155)	0.29
Blood loss (mL)	547.5 (210 - 1,820)	550.0 (70 - 2,120)	0.50
First oral intake (day)	3 (1 - 3)	2 (1 - 17)	0.25
First time leaving the bed (day)	1 (1 - 3)	1 (1 - 6)	0.63
Hospital after day	30.5 (19 - 40)	33 (18 - 74)	0.07

Table 1. Patient Characteristics in the Two Study Groups

No complications (n = 14)

Complications (n = 45)

P value

ASA-PS: American Society of Anesthesiologists - Physical Status; CONUT: controlling nutrition status; PNI: prognostic nutritional index; PD: pancreatoduodenectomy; DP: distal pancreatectomy; TP: total pancreatectomy.

ASA-PS (%)

1 (7.1)

2 (4.4)

0.23

12 (85.7)

30 (66.7)

1 (7.1)

13 (28.9)

Surgical technique

4 (28.6)

25 (55.6)

0.11

10 (71.4)

18 (40.0)

0 (0.0)

2 (4.4)

Sex

Men

5 (35.7)

20 (44.4)

0.75

Women

9 (64.3)

25 (55.6)

Age

67.5 (54 - 78)

74.0 (44 - 88)

0.02

Preoperative CONUT score

≤ 4

14 (100.0)

39 (86.7)

0.31

≥ 5

0 (0.0)

6 (13.3)

Preoperative PNI

< 40

0 (0.0)

4 (8.9)

0.56

> 40

14 (100.0)

41 (91.1)

Anesthesia time (h)

10.45 (6.7 - 14.8)

8.6 (3.5 - 14.9)

0.47

Operation time (h)

9.2 (5.5 - 13.6)

7.6 (2.5 - 13.6)

0.58

Infusion volume (mL)

2,725 (1,550 - 5,950)

2,500 (850 - 2,950)

0.72

Blood transfusion

6 (42.9)

28 (62.2)

0.22

Yes

8 (57.1)

17 (37.8)

Urine output (mL)

385 (50 - 1,280)

302 (80 - 1,155)

0.29

Blood loss (mL)

547.5 (210 - 1,820)

550.0 (70 - 2,120)

0.50

First oral intake (day)

3 (1 - 3)

2 (1 - 17)

0.25

First time leaving the bed (day)

1 (1 - 3)

1 (1 - 6)

0.63

Hospital after day

30.5 (19 - 40)

33 (18 - 74)

0.07

**Table 2.** Preoperative Blood Tests (or Examinations) in the Two Study Groups
	No complications (n = 14)	Complications (n = 45)	P value
ALB: albumin; TP: total protein; T-cho: total cholesterol; TLC: total lymphocyte count; CRP: C-reactive protein.
ALB (g/dL)	4.1 (3.3 - 4.8)	4.0 (2.3 - 4.2)	0.24
TP (g/dL)	6.8 (5.1 - 7.7)	6.8 (5.1 - 7.9)	0.44
T-cho (mg/dL)	195(116 - 141)	187 (120 - 270)	0.41
TLC (µL)	1,260 (274 - 2,290)	1,340 (114 - 2,883)	0.17
CRP (mg/dL)	0.05 (0.02 - 0.28)	0.11 (0.01 - 6.01)	0.16
Transferrin (mg/dL)	235.5(193 - 271)	241.0 (152 - 350)	0.82
Prealbumin (mg/dL)	24.1 (15.5 - 30.7)	24.1 (9.7 - 36.4)	0.70

Table 2. Preoperative Blood Tests (or Examinations) in the Two Study Groups

No complications (n = 14)

Complications (n = 45)

P value

ALB: albumin; TP: total protein; T-cho: total cholesterol; TLC: total lymphocyte count; CRP: C-reactive protein.

ALB (g/dL)

4.1 (3.3 - 4.8)

4.0 (2.3 - 4.2)

0.24

TP (g/dL)

6.8 (5.1 - 7.7)

6.8 (5.1 - 7.9)

0.44

T-cho (mg/dL)

195(116 - 141)

187 (120 - 270)

0.41

TLC (µL)

1,260 (274 - 2,290)

1,340 (114 - 2,883)

0.17

CRP (mg/dL)

0.05 (0.02 - 0.28)

0.11 (0.01 - 6.01)

0.16

Transferrin (mg/dL)

235.5(193 - 271)

241.0 (152 - 350)

0.82

Prealbumin (mg/dL)

24.1 (15.5 - 30.7)

24.1 (9.7 - 36.4)

0.70

**Table 3.** Status of Nutrition and Physical Function in the Two Study Groups
	Preoperative	Postoperative
CONUT: controlling nutrition status; PNI: prognostic nutritional index.
Sarcopenia
No	14 (100.0)	42 (93.3)	0.99	13 (100.0)	35 (87.5)	0.31
Yes	0 (0.0)	3 (6.7)		0 (0.0)	5 (12.5)
Walking speed (m/s)	1.45 (0.76 - 2.1)	0.93 (0.3 - 2.2)	0.01	1.03 (0.78 - 2.5)	0.98 (0.32 - 2.0)	0.37
Grip of hand (kg)	27.5 (16.0 - 47.5)	26.5 (9.5 - 54.0)	0.36	28.5 (13.6 - 47.5)	24.6 (13.0 - 57.0)	0.25
CONUT score (point)	2 (1 - 3)	2 (0 - 10)	0.51	3 (2 - 9)	4 (1 - 7)	0.26
PNI score	47.59 (3.50)	46.87 (5.56)	0.648
Survival
Mortality				2 (14.3)	13 (28.9)	0.606
Existence				11 (78.6)	29 (64.4)
Hospital after day				30.5 (19 - 40)	33 (18 - 74)	0.07

Table 3. Status of Nutrition and Physical Function in the Two Study Groups

Preoperative

Postoperative

No complications (n = 14)

Complications (n = 45)

P value

No complications (n = 14)

Complications (n = 45)

P value

CONUT: controlling nutrition status; PNI: prognostic nutritional index.

Sarcopenia

14 (100.0)

42 (93.3)

0.99

13 (100.0)

35 (87.5)

0.31

Yes

0 (0.0)

3 (6.7)

0 (0.0)

5 (12.5)

Walking speed (m/s)

1.45 (0.76 - 2.1)

0.93 (0.3 - 2.2)

0.01

1.03 (0.78 - 2.5)

0.98 (0.32 - 2.0)

0.37

Grip of hand (kg)

27.5 (16.0 - 47.5)

26.5 (9.5 - 54.0)

0.36

28.5 (13.6 - 47.5)

24.6 (13.0 - 57.0)

0.25

CONUT score (point)

2 (1 - 3)

2 (0 - 10)

0.51

3 (2 - 9)

4 (1 - 7)

0.26

PNI score

47.59 (3.50)

46.87 (5.56)

0.648

Survival

Mortality

2 (14.3)

13 (28.9)

0.606

Existence

11 (78.6)

29 (64.4)

Hospital after day

30.5 (19 - 40)

33 (18 - 74)

0.07

**Table 4.** Body Composition and Physical Function in the Two Study Groups in Pre- and Postoperative Periods
	Preoperative	Postoperative
BMI: body mass index.
Fat mass (kg)	10.75 (2.4 - 23.2)	16.50 (4.7 - 46.2)	0.02	8.6 (3.1 - 22.7)	14.2 (5.8 - 35.6)	0.09
BMI (kg/m²)	19.15 (15.8 - 27.1)	22.40 (16.8 - 35.2)	0.1	17.7 (14.8 - 26)	21.15 (15.6 - 34)	0.06
Muscle mass (kg)	36.3 (30.5 - 53.7)	35.7 (28.3 - 59.3)	0.92	33.3 (28.8 - 52.1)	35.8 (28.2 - 62.9)	0.25
Grip of hand (kg)	27.5 (16.0 - 47.5)	26.5 (9.5 - 54.0)	0.36	28.5 (13.6 - 47.5)	24.6 (13.0 - 57.0)	0.25

Table 4. Body Composition and Physical Function in the Two Study Groups in Pre- and Postoperative Periods

Preoperative

Postoperative

No complications (n = 14)

Complications (n = 45)

P value

No complications (n = 14)

Complications (n = 45)

P value

BMI: body mass index.

Fat mass (kg)

10.75 (2.4 - 23.2)

16.50 (4.7 - 46.2)

0.02

8.6 (3.1 - 22.7)

14.2 (5.8 - 35.6)

0.09

BMI (kg/m²)

19.15 (15.8 - 27.1)

22.40 (16.8 - 35.2)

0.1

17.7 (14.8 - 26)

21.15 (15.6 - 34)

0.06

Muscle mass (kg)

36.3 (30.5 - 53.7)

35.7 (28.3 - 59.3)

0.92

33.3 (28.8 - 52.1)

35.8 (28.2 - 62.9)

0.25

Grip of hand (kg)

27.5 (16.0 - 47.5)

26.5 (9.5 - 54.0)

0.36

28.5 (13.6 - 47.5)

24.6 (13.0 - 57.0)

0.25

**Table 5.** Comparison of Alterations of Body Composition and Physical Function in Pre- and Postoperative Periods in the Two Study Groups
	Comparison of before and after surgery
BMI: body mass index.
Fat mass (kg)	0 (-0.2 - 1.1)	-0.14 (-0.8 - 0.1)	0.02
BMI (kg/m²)	-0.06 (-0.09 - 0)	-0.05(-0.1 - 0.02)	0.9
Muscle mass (kg)	-0.05 (-0.17 - 0.01)	-0.04 (-0.17 - 0.09)	0.44
Grip strength of hand (kg)	-0.04 (-0.2 - 0.6)	-0.04 (-0.39 - 0.3)	0.56

Table 5. Comparison of Alterations of Body Composition and Physical Function in Pre- and Postoperative Periods in the Two Study Groups

Comparison of before and after surgery

No complications (n = 14)

Complications (n = 45)

P value

BMI: body mass index.

Fat mass (kg)

0 (-0.2 - 1.1)

-0.14 (-0.8 - 0.1)

0.02

BMI (kg/m²)

-0.06 (-0.09 - 0)

-0.05(-0.1 - 0.02)

0.9

Muscle mass (kg)

-0.05 (-0.17 - 0.01)

-0.04 (-0.17 - 0.09)

0.44

Grip strength of hand (kg)

-0.04 (-0.2 - 0.6)

-0.04 (-0.39 - 0.3)

0.56

**Table 6.** Logistic Regression Analysis, Univariate and Multivariable Logistic Regression Analysis of Risk Factors Associated With Postoperative Complications
	Univariate analysis	Multivariable logistic regression
Cut-off values were calculated from ROC curves for the four items of fat mass, age, walking speed, and fat mass change that differed significantly; and continuous variables were made binary. Logistic regression analysis was used to examine risk factors. CI: confidence interval.
Age	6.86	1.370 - 34.2	0.01	27.6	1.34 - 569.0	0.03
Walking speed	0.122	0.0244 - 0.609	0.01	0.119	0.0134 - 1.07	0.05
Fat mass	7.24	1.910 - 27.4	0.01	15.900	1.4900 - 168.0	0.02
Fat mass change rate	6.61	1.640 - 26.6	0.01	5.730	0.7590 - 43.2	0.09

Table 6. Logistic Regression Analysis, Univariate and Multivariable Logistic Regression Analysis of Risk Factors Associated With Postoperative Complications

Univariate analysis

Multivariable logistic regression

Odds ratio

95% CI

P value

Odds ratio

95% CI

P value

Cut-off values were calculated from ROC curves for the four items of fat mass, age, walking speed, and fat mass change that differed significantly; and continuous variables were made binary. Logistic regression analysis was used to examine risk factors. CI: confidence interval.

Age

6.86

1.370 - 34.2

0.01

27.6

1.34 - 569.0

0.03

Walking speed

0.122

0.0244 - 0.609

0.01

0.119

0.0134 - 1.07

0.05

Fat mass

7.24

1.910 - 27.4

0.01

15.900

1.4900 - 168.0

0.02

Fat mass change rate

6.61

1.640 - 26.6

0.01

5.730

0.7590 - 43.2

0.09