Early lipid–protein remodeling after pancreatic resection and palliative gastrointestinal bypass in pancreatic adenocarcinoma: a retrospective cohort study

Abstract Background Routine lipid parameters may provide accessible markers of postoperative metabolic adaptation after pancreatic cancer surgery, but their early perioperative trajectories remain incompletely characterized, particularly across different resectional and non-resectional procedures. We evaluated perioperative lipid-protein remodeling and its relationship with nutritional deterioration after pancreatic resection and palliative gastrointestinal surgery. Methods This retrospective single-center cohort included 213 adults with histopathologically confirmed pancreatic adenocarcinoma (resected specimen or biopsy) undergoing pancreaticoduodenectomy, distal pancreatectomy with splenectomy, palliative gastrojejunostomy, or exploratory laparotomy without resection. Preoperative and approximately 30-day postoperative lipid profile, albumin, total protein, and CA 19 − 9 were analyzed using paired tests, mixed-effects models, ANCOVA, and correlation analyses. Results At 30 days, albumin decreased by 8.65 g/L (95% CI -9.80 to -7.50; -21.3%; p < 0.001), HDL cholesterol by 9.0 mg/dL (-20.0%; p < 0.001), and total protein by 8.5 g/L ( p < 0.001); total and LDL cholesterol also decreased. Conversely, triglycerides increased by 34.5 mg/dL (95% CI + 21.0 to + 49.0; +30.3%; p < 0.001), predominantly after pancreatic resection, with a significant time × group interaction ( p = 0.002). CA 19 − 9 remained stable ( p = 0.68). Hypoalbuminaemia (< 35 g/L) occurred in 85.3% after palliative gastrojejunostomy and 67.7% after pancreaticoduodenectomy. In ANCOVA, postoperative albumin was lower after palliative gastrojejunostomy (β = -5.64 g/L; p = 0.003) and pancreaticoduodenectomy (β = -4.33 g/L; p = 0.02) versus distal pancreatectomy. Conclusions Early postoperative lipid-protein remodeling is common after pancreatic and palliative gastrointestinal surgery for pancreatic adenocarcinoma. The combination of generalized albumin/HDL decline and procedure-specific triglyceride increase after pancreatic resection suggests distinct postoperative metabolic phenotypes. Routine lipid fractions, particularly triglycerides and HDL cholesterol, may provide clinically accessible insight into early postoperative lipid-metabolic trajectories and help identify patients requiring closer nutritional and metabolic follow-up, although prospective validation is needed.