Scholarlink

Background <p>Cachexia is associated with worse postoperative outcomes, but the added role of neoadjuvant therapy (NAT) is unclear. This study evaluated whether preoperative cachexia and NAT act as a “double jeopardy” after pancreatoduodenectomy.</p> Patients and Methods <p>A nationwide observational cohort study was conducted using the Norwegian NORGAST registry (2016–2023). Adults undergoing pancreatoduodenectomy for malignancy were included. Cachexia was defined by consensus weight-loss criteria. Modified Poisson and Cox models (with a cachexia and NAT interaction term) estimated adjusted risk ratios (aRR) for textbook outcome (TO), prolonged length-of-stay (LOS), and adjusted hazard ratios (aHR) for overall survival.</p> Results <p>Of 1424 patients undergoing pancreatoduodenectomy, cachexia was present in 588 (41.3%). Having cachexia was associated with higher TO (aRR 1.28, 95% CI 1.13–1.46) with effect modification by body mass index (BMI) (interaction <i>P</i> = 0.047). Patients with cachexia had a lower risk of prolonged LOS (aRR 0.64, 95% CI 0.51–0.80). Cachexia was not independently associated with overall survival (aHR 1.15, 95% CI 0.97–1.36). NAT was associated with a higher hazard of death (aHR 1.44, 95% CI 1.09–1.92), likely reflecting confounding by indication. No statistically significant interaction between cachexia and NAT was observed for TO (<i>P</i> = 0.277) or for survival (<i>P</i> = 0.863).</p> Conclusions <p>Preoperative cachexia was associated with higher rates of TO. Higher TO was attributed to patients with overweight or obesity, to a shorter index stay, and more frequent transfers to a secondary facility, but not fewer complications. Cachexia was not associated with worse long-term survival, and a “double jeopardy” between cachexia and receiving NAT was not found.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Combined Impact of Neoadjuvant Therapy and Preoperative Cachexia in Patients Undergoing Pancreatoduodenectomy: Is There a “Double Jeopardy”? A National Cohort Study Investigating the Association with Short- and Long-Term Outcomes

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月5日

查看全文
  • Marcus Thomas Thor Roalsø,
  • Celine Oanaes,
  • Herish Garresori,
  • Karin Hestnes Edland,
  • Ingvild Dalen,
  • Hanne Røland Hagland,
  • Kjetil Søreide

摘要

Background

Cachexia is associated with worse postoperative outcomes, but the added role of neoadjuvant therapy (NAT) is unclear. This study evaluated whether preoperative cachexia and NAT act as a “double jeopardy” after pancreatoduodenectomy.

Patients and Methods

A nationwide observational cohort study was conducted using the Norwegian NORGAST registry (2016–2023). Adults undergoing pancreatoduodenectomy for malignancy were included. Cachexia was defined by consensus weight-loss criteria. Modified Poisson and Cox models (with a cachexia and NAT interaction term) estimated adjusted risk ratios (aRR) for textbook outcome (TO), prolonged length-of-stay (LOS), and adjusted hazard ratios (aHR) for overall survival.

Results

Of 1424 patients undergoing pancreatoduodenectomy, cachexia was present in 588 (41.3%). Having cachexia was associated with higher TO (aRR 1.28, 95% CI 1.13–1.46) with effect modification by body mass index (BMI) (interaction P = 0.047). Patients with cachexia had a lower risk of prolonged LOS (aRR 0.64, 95% CI 0.51–0.80). Cachexia was not independently associated with overall survival (aHR 1.15, 95% CI 0.97–1.36). NAT was associated with a higher hazard of death (aHR 1.44, 95% CI 1.09–1.92), likely reflecting confounding by indication. No statistically significant interaction between cachexia and NAT was observed for TO (P = 0.277) or for survival (P = 0.863).

Conclusions

Preoperative cachexia was associated with higher rates of TO. Higher TO was attributed to patients with overweight or obesity, to a shorter index stay, and more frequent transfers to a secondary facility, but not fewer complications. Cachexia was not associated with worse long-term survival, and a “double jeopardy” between cachexia and receiving NAT was not found.