Assessment of long term and short term outcomes in central versus subtotal pancreatectomy

Abstract

codes. The skeletal muscle area was measured at the third lumbar vertebra (L3) on CT imaging and indexed to patient height to calculate SMI. Sarcopenia was based on gender-specific cutoffs of SMI (52.4 cm2 /m2 in men and 38.5 cm2 /m2 in women). Results: We identified 159 patients in the study period undergoing PD with appropriate imaging for analysis. Median SMI of males (n=71) was 49.6 cm2 /m2 and females (n=88) was 37.2 cm2 /m2. The median SMI of female patients who required tube feeds at discharge (dTF) compared to females who did not was lower (32.0 [IQR 28.4-36.8] vs. 38.2 [IQR 34.7-45.7] cm2 /m2; p= 0.019). The median SMI of male patients who required dTF compared to patients who did not was also lower (42.9 [IQR 38.5-50.0] vs. 51.0 [IQR 45.3-56.4] cm2 /m2; p= 0.023). Receiver operating characteristic (ROC) curve analysis suggested SMI may be used to predict dTF for both females (AUC = 0.748) and males (AUC = 0.702). Youden's index analysis of these curves suggested a SMI cutoff of 32.5 cm2/m2 for females and 42.9 cm2/m2 for males as prognostic of dTF. Standard cutoffs for sarcopenia did not show a significant association with dTF by univariate logistic regression; however, the above proposed SMI cutoffs did correlate with dTF for both female (OR: 6.76, 95%CI 1.08-42.88) and male (OR: 4.54, 95%CI 1.01-20.45) patient populations. Conclusion: A significant association exists between very low SMI and postoperative enteral nutrition requirements, suggesting that the patients with severe sarcopenia undergoing PD may benefit from the placement of a feeding tube at the time of resection.