Abstract
INTRODUCTION: Weight loss is a prevalent complication after pancreatic cancer surgery. The primary objective of this study is to pinpoint the key predictors of weight restoration and persistent weight loss subsequent to pancreatic cancer surgery and to evaluate their effects on overall survival. METHODS: Between February 2022 and November 2022, we prospectively enrolled 186 consecutive patients undergoing surgery for primary pancreatic cancer. Body weight was systematically recorded preoperatively and at 1, 3, 6, and 12 months postoperatively. Patients were classified into three categories according to 12-month postoperative weight change tertiles: weight restoration, intermediate, and persistent weight loss. Regression analyses identified factors influencing weight change, and survival analyses assessed its impact on overall survival. RESULTS: Only 22.6% of patients regained or exceeded their preoperative weight by 12 months post-surgery. The median percentage of weight change at 1, 3, 6, and 12 months post - surgery was − 5.5%, -8.0%, -8.3%, and − 7.8%, respectively. Weight restoration was linked to diabetes and no vascular resection, while paradoxically also to lower preoperative hemoglobin and intra-abdominal infection. Conversely, persistent weight loss was significantly predicted by higher preoperative body mass index, elevated CA-199, combined vascular resection, and advanced TNM stage. Lower glycosylated haemoglobin (HbA1c) was also associated with weight loss, though this finding requires cautious interpretation. Postoperative weight change was significantly correlated with overall survival. CONCLUSION: Monitoring weight changes after surgery is crucial as they are closely associated with various clinical factors and significantly impact overall survivals, thus deserving attention in the comprehensive management of pancreatic cancer patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12957-026-04202-z.