Power of computed-tomography-defined sarcopenia for prediction of morbidity after pancreaticoduodenectomy

Abstract

Background The goal of our study was to evaluate the current approach in prediction of postoperative major complications after pancreaticoduodenectomy (PD), especially symptomatic pancreatic fistula (POPF), using parameters derived from computed tomography (CT). Methods Patients after PD were prospectively collected in a database of the local department of surgery and all patients with CT scans available were assessed in this study. CT parameters were measured at the level of the intervertebral disc L3/L4 and consisted of the areas of the visceral adipose tissue (A VAT ), the diameters of the pancreatic parenchyma (DPP) and the pancreatic duct (DPD), the areas of ventral abdominal wall muscle (A MVEN ), psoas muscle (A MPSO ), paraspinal muscle (A MSPI ), total muscle (A MTOT ), as well as the mean muscle attenuation (MA) and skeletal muscle index (SMI). Mann-Whitney-U Test for two independent samples and binary logistic regression were used for statistical analysis. Results One hundred thirty-nine patients (55 females, 84 males) were included. DPD was 2.9 mm (Range 0.7–10.7) on median and more narrow in patients with complications equal to or greater stadium IIIb ( p < 0.04) and severe POPF ( p < 0.01). DPP median value was 17 (6.9–37.9) mm and there was no significant difference regarding major complications or POPF. A VAT showed a median value of 127.5 (14.5–473.0) cm 2 and was significantly larger in patients with POPF ( p < 0.01), but not in cases of major complications ( p < 0.06). A MPSO , A MSPI , A MVEN and A MTOT showed no significant differences between major complications and POPF. MA was both lower in groups with major complications ( p < 0.01) and POPF ( p < 0.01). SMI failed to differentiate between patients with or without major complications or POPF. Conclusion Besides the known factors visceral obesity and narrowness of the pancreatic duct, the mean muscle attenuation can easily be examined on routine preoperative CT scans and seems to be promising parameter to predict postoperative complications and POPF.

Prognostic role of body composition parameters in gastric/gastroesophageal junction cancer patients from the EXPAND trial

“…who were blinded to clinical data. Segmentation of CT data was performed using a custom made and recently published software tool . Briefly, the tool starts by standardizing the thickness of CT slices to 1 mm.…”

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

“…It varies among individuals as a result of differences in age, body density, and the degree of obesity. [5][6][7] In the face of critical organ shortage with increased utilization of marginal allografts procured from extended criteria donors (ECD), one of the most challenging clinical decisions in the liver transplantation setting is the optimal risk-quantification and the identification of high-risk recipients and/or donor-recipient combinations. 2,3 Besides the pure loss of muscle mass and function known as sarcopenia, qualitative structural changes, such as myosteatosis, characterized by the presence of inter-and intramyocellular fat deposition, 4 have been shown to be associated with reduced muscle strength and poor clinical outcomes in patients undergoing surgery for colorectal or pancreatic cancer.…”

“…2,3 Besides the pure loss of muscle mass and function known as sarcopenia, qualitative structural changes, such as myosteatosis, characterized by the presence of inter-and intramyocellular fat deposition, 4 have been shown to be associated with reduced muscle strength and poor clinical outcomes in patients undergoing surgery for colorectal or pancreatic cancer. [5][6][7] In the face of critical organ shortage with increased utilization of marginal allografts procured from extended criteria donors (ECD), one of the most challenging clinical decisions in the liver transplantation setting is the optimal risk-quantification and the identification of high-risk recipients and/or donor-recipient combinations. 8 In this regard, several clinical risk-assessment systems, using donor and recipient factors (eg, Balance-of-Risk or BAR score), have been developed over the past 10-15 years.…”

Skeletal Muscle Depletion and Nutrition Support Affected Postoperative Complications in Patients Underwent Pancreatoduodenectomy

“…Amini et al reported higher risk of morbidity and complication was observed in patients with sarcopenia after curative resection for pancreatic adenocarcinoma [25]. Recently, both Nicolas and Minji et al have demonstrated mean muscle attenuation could be a promising parameter to predict complications and POPF after PD [6,7]. In addition to short-term results, long-term outcome also seems to relate to skeletal muscle conditions.…”

“…Lately, preoperative visceral obesity and sarcopenia have been shown associated with major complications in patients with pancreatic ductal adenocarcinoma (PDAC) [4,5]. Meanwhile, several studies began to reveal the close relationship between sarcopenia and postoperative pancreatic stula (POPF) in patients receiving PD [6][7][8]. However, the de nition and diagnosis of sarcopenia varied greatly in these studies and body composition differed in various population [9,10].…”