Malnutrition and Related Nutritional Classifications in Patients Undergoing Pancreatic Surgery: A Systematic Review of Assessment Methods and Associated Factors

Aims To summarize study-specific reports of malnutrition and related nutritional classifications across nutritional assessment methods in patients undergoing pancreatic surgery and to synthesize the available evidence on associated factors. Methods Multiple databases were searched for studies reporting malnutrition or related nutritional outcomes in patients undergoing pancreatic surgery. Study-specific nutritional outcomes were summarized descriptively according to the assessment method and outcome construct. Associated factors were synthesized narratively, with adjusted estimates prioritized when available. Results A total of 13 studies involving 1,890 patients were included. Nine studies reported malnutrition or related nutritional classifications using GLIM, PG-SGA, SGA, MNA, or PNI. Among four studies applying GLIM criteria, the proportion of patients classified as malnourished ranged from 48.6% to 70.0%. Results based on PG-SGA, SGA, MNA, and PNI were summarized separately according to the classifications used in the original studies. No overall prevalence estimate was calculated because these assessment approaches represented non-equivalent nutritional constructs. Older age, smoking exposure, BMI, preoperative serum albumin, primary disease type and surgical characteristics were examined in individual studies, but the evidence was limited by heterogeneous outcome definitions, follow-up periods, and adjustment models. Conclusion Malnutrition and related nutritional impairment are frequently reported among patients undergoing pancreatic surgery, although reported estimates vary across nutritional assessment methods and clinical contexts. Heterogeneity in assessment constructs and methods precluded estimation of a clinically meaningful overall prevalence. Evidence on associated factors remains limited and inconsistent. Greater standardization of nutritional assessment methods and outcome reporting may improve comparability among future studies.