Nutritional and anthropometric assessment of the scope for dietary optimization during staging prior to pancreaticoduodenectomy

Context: Although several studies have examined peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy all provided support at various timepoints with a variety of protocols. Objective: This study undertakes a detailed nutritional and anthropometric assessment of patients due to undergo pancreaticoduodenectomy with particular reference to pre-operative nutritional status and perioperative outcome. Patients: Twenty-six patients undergoing pancreaticoduodenectomy. Setting: A regional hepatobiliary service. Main outcome measures: Nutritional, anthropometric and clinical course details. Design: Data were collected prospectively. Results: There was no significant change in any anthropometric index from baseline to immediately prior to surgery. However, there was a significant fall in BMI comparing baseline measurements to observations at time of discharge from hospital (P<0.001). There was, in addition, a significant difference between baseline and BMI at 3 months (P<0.001). Similar trends were observed in mid-arm circumference, triceps skin fold thickness and hand-grip. There was no in-hospital or 3-month post-operative mortality in this series. Conclusion: Nutritional and anthropometric indices remain stable from the time of index admission to operation. However, there is a drastic and sustained reduction in nutritional indices in the post-operative period with this deficiency being sustained at 3-months after operation.