Exocrine Pancreatic Insufficiency and Nutritional Status in Patients with Resectable and Borderline Resectable...

Exocrine pancreatic insufficiency (EPI) and malnutrition are prevalent but systematically underestimated in patients with periampullary tumors.

Prospective observational single-center study. Thirty-two patients with potentially resectable periampullary tumors underwent nutritional assessment including fecal elastase-1 (FE-1), psoas muscle index (PMI) on CT, bioelectrical impedance analysis (BIA) with phase angle, and handgrip strength. Postoperative complications, Textbook Outcome (TO), and nutritional follow-up at 1, 3, and 6 months were assessed in 23 resected patients. EPI (FE-1 <200 mcg/g) was present in 76.9% (20/26). Prealbumin was <20 mg/dL in 62.1% and vitamin D deficient in 82.8%, despite normal albumin in most patients. Sarcopenia by PMI was detected in 53.1% (17/32) of the full preoperative cohort, substantially higher than handgrip strength alone (15-17%). After resection, universal EPI (100%) was confirmed. TO was achieved in 73.9% (17/23). Median weight declined from 64.0 kg preoperatively to 61.2 kg at 6 months; cumulative weight loss from pre-illness habitual weight reached 18.5% at 6 months, of which 9.2% had already occurred before surgery. Vitamin D deficit persisted throughout follow-up; sarcopenia was numerically higher at 1 month (68.8%), with values returning toward baseline by 6 months (65.2%).

Patients with periampullary tumors present a severe, multidimensional preoperative nutritional burden more prevalent than recognized. Systematic assessment should be incorporated into standard protocols within a structured multidisciplinary perioperative pathway.