Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

Cai, Zhenning; Yang, Yong; Fang, Xu; Liang, Mao; Qiu, Yudong

doi:10.1159/000529429

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…In the bicompartment model, the human body is composed of FFM, which includes, under physiological conditions, the following components: bone mineral content (≈7%), extracellular water (≈29%), intracellular water (≈44%), and visceral protein (=20%). BIA estimation of body composition is based on body fluid volume measurement using a BIA resistance value; for these reasons, an alteration of these compartments can represent prognostic or diagnostic parameters in many diseases [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of BIA Analysis in Osteoporosis Risk Development: Hierarchical Clustering Approach

et al. 2023

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Osteoporosis is a common musculoskeletal disorder among the elderly and a chronic condition which, like many other chronic conditions, requires long-term clinical management. It is caused by many factors, including lifestyle and obesity. Bioelectrical impedance analysis (BIA) is a method to estimate body composition based on a weak electric current flow through the body. The measured voltage is used to calculate body bioelectrical impedance, divided into resistance and reactance, which can be used to estimate body parameters such as total body water (TBW), fat-free mass (FFM), fat mass (FM), and muscle mass (MM). This study aims to find the tendency of osteoporosis in obese subjects, presenting a method based on hierarchical clustering, which, using BIA parameters, can group patients who show homogeneous characteristics. Grouping similar patients into clusters can be helpful in the field of medicine to identify disorders, pathologies, or more generally, characteristics of significant importance. Another added value of the clustering process is the possibility to define cluster prototypes, i.e., imaginary patients who represent models of “states”, which can be used together with clustering results to identify subjects with similar characteristics in a classification context. The results show that hierarchical clustering is a method that can be used to provide the detection of states and, consequently, supply a more personalized medicine approach. In addition, this method allowed us to elect BIA as a potential prognostic and diagnostic instrument in osteoporosis risk development.

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Section: Discussionmentioning

confidence: 99%

The Role of BIA Analysis in Osteoporosis Risk Development: Hierarchical Clustering Approach

et al. 2023

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“…Therefore, we hypothesized that perioperative dexamethasone could reduce overall complications in the entire cohort by at least 30%. The overall morbidity after pancreaticoduodenectomy, including Clavien-Dindo grades I to V, has been reported to be at least 60% 3,25–27 . We chose the CCI as the primary outcome because it is more sensitive and requires a smaller sample size compared with the Clavien-Dindo classification in clinical trials 19 .…”

Section: Methodsmentioning

confidence: 99%

“…The overall morbidity after pancreaticoduodenectomy, including Clavien-Dindo grades I to V, has been reported to be at least 60%. 3,[25][26][27] We chose the CCI as the primary outcome because it is more sensitive and requires a smaller sample size compared with the Clavien-Dindo classification in clinical trials. 19 We estimated that the enrolment of 128 patients per arm would provide 80% power with an α-error of 0.05 to detect a 30% relative reduction in the rate of postoperative complications.…”

Section: Statistical Analysesmentioning

confidence: 99%

The Effect of Perioperative Dexamethasone on Postoperative Complications after Pancreaticoduodenectomy

Chen,

Wang,

Jiang

et al. 2024

Annals of Surgery

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Objective: This study aimed to evaluate the effect of perioperative dexamethasone on postoperative complications after pancreaticoduodenectomy. Background: The glucocorticoid dexamethasone has been shown to improve postoperative outcomes in surgical patients, but its effects on postoperative complications after pancreaticoduodenectomy are unclear. Methods: This multicenter, double-blind, randomized controlled trial was conducted in four Chinese high-volume pancreatic centers. Adults undergoing elective pancreaticoduodenectomy were randomized to receive either 0.2 mg/kg dexamethasone or a saline placebo as an intravenous bolus within 5 minutes after anesthesia induction. The primary outcome was the Comprehensive Complication Index (CCI) score within 30 days after the operation, analyzed using the modified intention-to-treat principle. Results: Among 428 patients for eligibility, 300 participants were randomized and 265 were included in the modified intention-to-treat analyses. 134 patients received dexamethasone and 131 patients received a placebo. The mean (SD) CCI score was 14.0 (17.5) in the dexamethasone group and 17.9 (20.3) in the placebo group (mean difference, −3.8; 95% CI, −8.4 to 0.7; P=0.100). The incidence of major complications (Clavien-Dindo grade ≥III) (12.7% vs. 16.0%, risk ratio 0.79; 95% CI, 0.44 to 1.43; P=0.439) and postoperative pancreatic fistula (25.4% vs. 31.3%, risk ratio 0.81; 95% CI, 0.55 to 1.19; P=0.286) were not significantly different between the two groups. In the stratum of participants with a main pancreatic duct ≤3 mm (n=202), the CCI score was significantly lower in the dexamethasone group (mean difference, -6.4; 95% CI, −11.2 to −1.6; P=0.009). Conclusion: Perioperative dexamethasone did not significantly reduce postoperative complications within 30 days after pancreaticoduodenectomy.

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“…The results showed no clear differences in the incidence of CR-POPFs between sarcopenic and non-sarcopenic patients [ 4 ]. In contrast, a more recent retrospective analysis of 129 patients (30% of whom had pancreatic cancer) who underwent pancreaticoduodenectomy showed that preoperative, CT-based diagnosis of sarcopenia and visceral obesity were significant predictors of CR-POPFs and a high comprehensive complication score (CCI) [ 22 ]. These inconclusive results might be attributed to the small sample sizes, heterogeneous study populations and indications, and above all, the non-standardized measurement parameters and cut-off values used for sarcopenia and other body composition abnormalities determined by CT [ 4 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Associations of body composition parameters with postoperative outcome and perineural tumour invasion after oncological pancreatic resection

Mueller,

Henselmann,

Reischl

et al. 2024

BMC Surg

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Background Pancreatic cancer is often accompanied by wasting conditions. While surgery is the primary curative approach, it poses a substantial risk of postoperative complications, hindering subsequent treatments. Therefore, identifying patients at high risk for complications and optimizing their perioperative general condition is crucial. Sarcopenia and other body composition abnormalities have shown to adversely affect surgical and oncological outcomes in various cancer patients. As most pancreatic tumours are located close to the neuronal control centre for the digestive tract, it is possible that neural infiltration in this area deranges bowel functions and contributes to malabsorption and malnutrition and ultimately worsen sarcopenia and weight loss. Methods A retrospective analysis of CT scans was performed for pancreatic cancer patients who underwent surgical tumour resection at a single high-volume centre from 2007 to 2023. Sarcopenia prevalence was assessed by skeletal muscle index (SMI), and visceral obesity was determined by the visceral adipose tissue area (VAT). Obesity and malnutrition were determined by the GLIM criteria. Sarcopenic obesity was defined as simultaneous sarcopenia and obesity. Postoperative complications, mortality and perineural tumour invasion, were compared among patients with body composition abnormalities. Results Of 437 patients studied, 46% were female, the median age was 69 (61;74) years. CT analysis revealed 54.9% of patients with sarcopenia, 23.7% with sarcopenic obesity and 45.9% with visceral obesity. Sarcopenia and sarcopenic obesity were more prevalent in elderly and male patients. Postoperative surgical complications occurred in 67.7% of patients, most of which were mild (41.6%). Severe complications occurred in 22.7% of cases and the mortality rate was 3.4%. Severe postoperative complications were significantly more common in patients with sarcopenia or sarcopenic obesity. Visceral obesity or malnutrition based on BMI alone, did not significantly impact complications. Perineural invasion was found in 80.1% of patients and was unrelated to malnutrition or body composition parameters. Conclusions This is the first and largest study evaluating the associations of CT-based body mass analysis with surgical outcome and histopathological perineural tumour invasion in pancreatic cancer patients. The results suggest that elderly and male patients are at high risk for sarcopenia and should be routinely evaluated by CT before undergoing pancreatic surgery, irrespective of their BMI. Confirmation of the results in prospective studies is needed to assess if pancreatic cancer patients with radiographic sarcopenia benefit from preoperative amelioration of muscle mass and function by exercise and nutritional interventions.

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Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

Cited by 6 publications

References 22 publications

The Role of BIA Analysis in Osteoporosis Risk Development: Hierarchical Clustering Approach

The Role of BIA Analysis in Osteoporosis Risk Development: Hierarchical Clustering Approach

The Effect of Perioperative Dexamethasone on Postoperative Complications after Pancreaticoduodenectomy

Associations of body composition parameters with postoperative outcome and perineural tumour invasion after oncological pancreatic resection

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