Impact of body constitution on complications following pancreaticoduodenectomy: A retrospective cohort study

Ekström, Eva Charlotte; Ansari, Daniel; Williamsson, Caroline; Andersson, Roland; Tingstedt, Bobby; Aronsson, Linus; Nilsson, Johan; Andersson, Bodil

doi:10.1016/j.ijsu.2017.10.035

Cited by 18 publications

(19 citation statements)

References 41 publications

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“…4 However, the best quantification method for this is undetermined, and both BMI, body surface area (BSA) and body fat percentage (BF%) have been associated with increased risk for POPF. 30,31 Common to several scores are that BMI and pancreatic duct size together are strong predictors of the risk of POPF, with increasing BMI and decreasing size of the duct significantly associated with exponentially increased POPF risk. 4,32,33 In addition to obesity, the concurrent association of sarcopenia is an additional reported risk factor for POPF.…”

Section: Patient-related Factorsmentioning

confidence: 99%

Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery

Søreide

Healey

Mole

et al. 2019

HPB

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Background: The most hazardous complication to pancreatic surgery is the development of a postoperative pancreatic fistula (POPF). Appropriate understanding of the underlying pathophysiology, risk factors and perioperative mechanisms may allow for better management and use of preventive measures.Methods: Systematic literature search using the English PubMed literature up to April 2019, with emphasis on the past 5 years. Results: Several risk scores have been developed but none are perfect in predicting POPF risk. A conceptual framework of factors that contribute to the pathophysiology of pancreatic fistulae is still developing but incomplete. Recognized factors include those related to the patient, the pathology and the perioperative care. Interventions such as use of drains, stents and various drugs to mediate risk is still debated. Emerging data suggest that both the microbiome and the inflammation in the post-operative phase may play important roles in risk for POPF. Available risk scores allow for stratification of risk and mitigation strategies tailored to reduce this. However, accurate estimation of risk remains a challenge and mechanisms are only partially understood. Conclusions: The pathophysiology of POPF remains poorly understood. Current models only partially explain risks or associated mechanisms. Novel areas of investigation need to be explored for better prediction.

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Section: Patient-related Factorsmentioning

confidence: 99%

Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery

Søreide

Healey

Mole

et al. 2019

HPB

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“…This would increase the surgical challenges and surgical morbidities in digestive surgeries. Previous studies from Western countries have shown that overweight patients receiving OPD may have increased operation time, blood loss [30], and surgical morbidities [10,12,13] compared to normal-weight patients. Chang et al presented data from the National Clinical Database in the United States, which showed that obesity increased the risk of wound infection, reoperation, failure of extubation in 48 h, infection, pulmonary embolism, and renal insufficiency compared to the control group [11].…”

Section: Discussionmentioning

confidence: 99%

“…The mortality rate substantially decreases to 2-5%, and the postoperative morbidity remains as high as 40-60% [6][7][8][9]. Previous studies have reported increased morbidity and mortality in obese patients undergoing open pancreaticoduodenectomy (OPD) when compared with non-obese patients [10][11][12][13]. The robotic platform provides surgeons with ergonomic conditions and dexterity and has an increasing application in general, urological, and gynecological procedures; however, the penetration of robotic pancreaticoduodenectomy (RPD) is still slow and uncommon owing to the complex high-risk procedure and steep learning curve.…”

Section: Introductionmentioning

confidence: 99%

Impact of body mass index on the early experience of robotic pancreaticoduodenectomy

Chao

Liao

et al. 2021

Updates Surg

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Obesity increases surgical morbidity and mortality in open pancreaticoduodenectomy (OPD). Its influence on robotic pancreaticoduodenectomy (RPD) remains uncertain. This study aimed to investigate the impact of body mass index (BMI) on the early experience of RPD. Between June 2015 and April 2020, 68 consecutive RPDs were performed at the National Cheng Kung University Hospital. The patients were categorized as normal-weight (BMI < 23 kg/m2), overweight (BMI = 23–27.5 kg/m2), and obese (BMI > 27.5 kg/m2) according to the definition of obesity in Asian people from the World Health Organization expert consultation. Preoperative characteristics, operative details, and postoperative outcomes were prospectively collected. The cumulative sum was used to assess the learning curves. The average age of the patients was 64.8 ± 11.7 years with an average BMI of 24.6 ± 3.7 kg/m2 (23 normal-weight, 29 overweight, and 16 obese patients). Eighteen patients were required to overcome the learning curve. The overall complication rate was 51.5%, and the major complication rate (Clavien grade ≥ III) was 19.1%. The normal-weight group showed the most favorable outcomes. The blood loss, major complication rate, peripancreatic fluid collection rate, and conversion rate were higher in the obese group than in the non-obese group. There were no differences in the operative time, clinically relevant postoperative pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, bile leak, wound infection, reoperation, hospital stay, and readmission rate between the obese and non-obese groups. Multivariate analysis showed obesity as the only independent factor for major complications (OR: 5.983, CI: 1.394–25.682, p = 0.001), indicating that obesity should be considered as a surgical risk factor during the implementation of RPD.

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“…Most of the findings in this study are not controversial and support previously published papers. Presence of diabetes and a preoperative biliary drainage are features described earlier related to a reduced risk of POPF [ 20 , 21 ] as well as tumour location and its correlation to POPF [ 4 , 18 , 22 ]. These are parameters associated with inflammation of the parenchyma or obstruction of the pancreatic duct, leading to pancreatic firmness.…”

Section: Discussionmentioning

confidence: 99%

“…Obese patients have an increased risk of overall complications after PD, and several studies have shown an increased risk for POPF specifically [ 2 , 20 , 21 , 26 ]. Here, median BMI was higher for the group with POPF, and higher BMI was independently correlated with POPF.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Postoperative Pancreatic Fistula—A Swedish Nationwide Register‐Based Study

et al. 2020

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Background A serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by using a large nationwide cohort. Methods Data from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients undergoing a PD from 2010 until 30th June 2018 were collected. The material was analysed in two groups, no POPF and clinically relevant (grade B and C) POPF. Results A total of 2503 patients underwent PD, of which 245 (10%) developed POPF. Patients with POPF had significantly more overall complications (Clavien Dindo ≥3a, 75% vs. 21%, p < 0.001) and longer hospital stay (median 23 [16–35] vs. 11 [8–15], p < 0.001) than patients without POPF. The risk of POPF was higher with increased BMI (OR 1.08, p < 0.001). Preoperative presence of diabetes (OR 0.52, p = 0.012) and preoperative biliary drainage (OR 0.34, p < 0.001) reduced the risk of POPF. Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy (OR 2.41, p < 0.001). Weight gain ≥2 kg on postoperative day 1 was also a risk factor (OR 1.76, p < 0.001). Conclusion A high BMI, a pancreaticojejunostomy and postoperative weight gain were risk factors for developing POPF. Diabetes or preoperative biliary drainage was protective.

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Impact of body constitution on complications following pancreaticoduodenectomy: A retrospective cohort study

Abstract: Body constitution has an impact on the risk of severe complications following PD. BMI, BSA and BF% can all be used to identify risk groups. The risk of developing POPF grades B and C was significantly increased in overweight and large patients, but not in patients with coexisting diabetes.

Cited by 18 publications

References 41 publications

Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery

Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery

Impact of body mass index on the early experience of robotic pancreaticoduodenectomy

Predictive Factors for Postoperative Pancreatic Fistula—A Swedish Nationwide Register‐Based Study

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