Body Composition Influences Post-Operative Complications and 90-Day and Overall Survival in Pancreatic Surgery Patients

Abstract

<b><i>Introduction:</i></b> Pancreatic surgery still carries a high morbidity and mortality even in specialized centers. The aim of this study was to evaluate the influence of patients’ body composition on postoperative complications and survival after pancreatic surgery. <b><i>Methods:</i></b> This was a retrospective study on patients undergoing pancreatic surgery between March 2012 and December 2017. Demographics, clinical data, and postoperative complications classified according to Clavien-Dindo were recorded. Body composition was assessed using routine diagnostic or staging computed tomography (CT). Multiple Cox proportional hazards models were adjusted. <b><i>Results:</i></b> Ninety patients were included, 55% were male, and the mean age was 68 ± 10.9 years. Of these 90, 92% had a total pancreatectomy or pancreaticoduodenectomy, 7% a distal pancreatectomy, and 1% a pancreaticoduodenectomy with multi-visceral resection; 84% had malignant disease. The incidence of major complications was 27.8% and the 90-day mortality was 8.8%. The ratio of visceral fat area/skeletal muscle area (VFA:SMA) was associated with an increased risk of complications (OR 2.24, 95% CI 1.14–4.87, <i>p</i> = 0.03) and 90-day survival (HR 2.13, 95% CI 1.13–4.01, <i>p</i> = 0.019). On simple analysis, shorter overall survival (OS) was observed in patients aged ≥70 years (<i>p</i> = 0.0009), with postoperative complications ≥IIIb (<i>p</i> = 0.01), an increased VFA:SMA (<i>p</i> = 0.007), and decreased muscle radiation attenuation (<i>p</i> = 1.6 × 10<sup>–5</sup>). In an OS model adjusted for age, disease malignancy, postoperative complications, and body composition parameters, muscle radiation attenuation remained significantly associated with survival (HR 0.94, 95% CI 0.90–0.98, <i>p</i> = 0.0016). A model which included only body composition variables had a discrimination ability (<i>C</i>-statistic 0.76) superior to a model which comprised conventional clinical variables (<i>C</i>-statistic 0.68). <b><i>Conclusion:</i></b> Body composition is a major determinant of postoperative complications and survival in pancreatic surgery patients.

Selected Body Composition Parameters Analysis Based on Bioelectrical Impedance in Patients Operated for Gastrointestinal Cancer

“…In the studies of other authors, among patients with pancreatic diseases, a similar number of serious complications was found, which amounted to 27.8% (48). In subsequent studies in patients with colorectal cancer, it was found that preoperative body composition and short-term weight loss were not associated with postoperative complications over a 30-day follow-up (49).…”

High Systemic Immune Inflammation Index Is Associated With Low Skeletal Muscle Quantity in Resectable Pancreatic Ductal Adenocarcinoma

“…Despite the association shown in our results between low skeletal muscle mass and elevated SIII, we did not observe an association between low skeletal muscle mass and cancer-specific or disease-free survival. Findings conflict with the few studies on the prognostic value of low skeletal muscle mass for cancerspecific or disease-free survival in PDAC patients, possibly due to the small sample sizes and the heterogeneity of the included patient groups in previous studies (42,43). Furthermore, varying definitions and assessment methods for sarcopenia and skeletal muscle in cancer patients are used in the literature (44,45).…”

Impact of preoperative muscle mass and quality on surgical outcomes in patients undergoing major hepatectomy for perihilar cholangiocarcinoma

“…Several previous reports indicated that body composition indices are highly associated with short‐ and long‐term outcomes following resection for various gastrointestinal cancers 3 . The representative indices for body composition include muscle mass and quality.…”

“…Several previous reports indicated that body composition indices are highly associated with short-and long-term outcomes following resection for various gastrointestinal cancers. 3 The representative indices for body composition include muscle mass and quality. The total psoas area (TPA) at the level of the third vertebra has been used as the former, 4 whereas the average Hounsfield units (HU) of the TPA have been used as the latter.…”