Exocrine Pancreatic Insufficiency and Nutritional Status in Patients with Resectable and Borderline Resectable Periampullary Tumors: A Prospective Longitudinal Study.

BACKGROUND: Exocrine pancreatic insufficiency (EPI) and malnutrition are prevalent but systematically underestimated in patients with periampullary tumors. SUMMARY: 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%). KEY MESSAGES: 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.