Postoperative Changes in Nutritional Status and their Impact on Post-recurrence Prognosis After Pancreatoduodenectomy in Patients With Biliary Tract Carcinoma: An Age-stratified Analysis

Background/Aim: To clarify postoperative changes in nutritional status and their impact on post-recurrence prognosis after pancrexatoduodenectomy in patients with biliary tract carcinoma based on age and recurrence status.

Patients and Methods: We compared 91 patients aged ≥70 years and 68 patients aged <70 years and evaluated the relationship between postoperative nutritional indices and prognosis.

Results: Although the 5-year recurrence-free survival rates were similar between the two groups (≥70 years, 48.6%; <70 years: 59.3%, p=0.31), the median post-recurrence survival time and the 5-year overall survival rate were significantly worse in older patients (≥70 vs. <70 years: 1.1 vs. 1.7 years, p=0.0024; and 48.8% vs. 69.3%, p=0.0080). In patients with recurrence, many nutritional statuses at recurrence and the rate of treatment after recurrence were significantly poorer in elderly patients; however, no age-related differences in these indices were observed in patients without recurrence. Moreover, among elderly patients, these nutritional parameters were significantly lower in those with recurrence than in those without, whereas they were comparable among younger patients. In the multivariate analyses, no treatment after recurrence was an independent factor for poor post-recurrence survival (hazard ratio=2.1). Furthermore, age ≥70 years at initial surgery and low serum cholinesterase levels at recurrence were risk factors for treatment after recurrence (odds ratios of 0.22 and 0.11).

Conclusion: Only elderly patients with recurrence had poorer nutritional indices at recurrence, resulting in a lower rate of post-recurrence treatment and shorter post-recurrence survival.