Impact of Preoperative Osteosarcopenia and Postoperative Administration of Pancrelipase on the Prognosis of Borderline Resectable and Unresectable Locally Advanced Pancreatic Cancer

• Published in: The American surgeon 2025-01, Vol.91 (1), p.65-75
• Main Authors: Matsumoto, Michinori, Uwagawa, Tadashi, Shirai, Yoshihiro, Tsunematsu, Masashi, Furukawa, Kenei, Haruki, Koichiro, Okui, Norimitsu, Okazaki, Kohei, Ishizaki, Shunta, Ikegami, Toru
• Format: Article
• Language: English
• Subjects: Adjuvants; Aged; Aged, 80 and over; Antigens; Cancer; Cancer therapies; Chemotherapy; Chemotherapy, Adjuvant; Disease-Free Survival; Enzymes; Female; Hospitals; Humans; Lipase - blood; Lymph nodes; Magnetic resonance imaging; Male; Medical prognosis; Metastases; Metastasis; Middle Aged; Neoplasm Recurrence, Local; Nutritional status; Osteopenia; Outpatient care facilities; Pancreatectomy; Pancreatic cancer; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Patients; Pharmaceuticals; Postoperative Care - methods; Prognosis; Retrospective Studies; Sarcopenia; Surgeons; Surgery; Survival; Tomography; Vertebrae
• ISSN: 0003-1348; 1555-9823; 1555-9823
• DOI: 10.1177/00031348241272420

Background This study aimed to identify postoperative recurrence and prognostic factors, including osteosarcopenia for borderline resectable (BR) and unresectable locally advanced (UR-LA) pancreatic cancer and to examine the impact of postoperative pancreatic enzyme replacement therapy (PERT). Methods We retrospectively examined 32 resected patients with BR and UR-LA pancreatic cancer. We investigated independent factors in the disease-free survival and overall survival. The relation of osteosarcopenia with the clinicopathological factors was investigated. Additionally, the association of the administration of a standard dose of pancrelipase, the amount of lipase required for patients with pancreatic exocrine insufficiency, for ≥6 months postoperatively with improvement of sarcopenia, osteopenia, and osteosarcopenia and completion rate of adjuvant chemotherapy was investigated. Results Multivariate analyses identified osteosarcopenia (P = 0.049) and lymph node metastasis (P = 0.01) as independent recurrence predictors, and osteosarcopenia (P = 0.002), maximum tumor diameter ≥40 mm (P = 0.006), and no adjuvant therapy (P = 0.01) as independent prognostic predictors. In the osteosarcopenia group, serum CA19-9 levels were higher (P = 0.03). The administration of a standard dose of pancrelipase for ≥6 months postoperatively was none in the osteosarcopenia group (0% vs 42.9%, P = 0.01), while significantly improved postoperative sarcopenia (33% vs 0%, P = 0.004), increased number of cycles of adjuvant chemotherapy (n = 6 vs n = 3, P = 0.03), and the completion rate of adjuvant chemotherapy in excluding cases interrupted because of recurrence (86% vs 25%, P = 0.007). Conclusions Osteosarcopenia was an independent recurrent and prognostic factor in patients after pancreatectomy for locally advanced pancreatic cancer. Appropriate postoperative PERT may contribute to a better prognosis by improving sarcopenia and increasing the completion rate of adjuvant chemotherapy.