title: Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy.
abstract: OBJECTIVE
  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 HbA1c 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 HbA1c levels over 7% had much poorer overall survival than those with HbA1c levels less than 7% (9.3 movs27.6 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.
  
  
  CONCLUSIONS
  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 long-term outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.
authors.affiliation: Hao-Jun Shi, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Hao-Jun
authors.initials: HJ
authors.lastname: Shi
authors.affiliation: Hao-Jun Shi, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Jin
authors.affiliation: Hao-Jun Shi, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: De-Liang
authors.initials: DL
authors.lastname: Fu
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D018572:Disease-Free Survival; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D009752:Nutritional Status; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011184:Postoperative Period; D011228:Prealbumin / Q000032:analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D011228:Prealbumin
keywords: Complication; Glycemic control; Nutritional status; Prognosis; Total pancreatectomy; Tumor recurrence