Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy

Abstract

BackgroundRecently, skeletal muscle depletion (sarcopenia) has been reported to influence postoperative outcomes after certain procedures. This study investigated the impact of sarcopenia on postoperative outcomes following pancreaticoduodenectomy (PD).MethodsWe performed a retrospective study of consecutive patients (n = 219) who underwent PD at our institution between January 2007 and May 2013. Sarcopenia was evaluated using preoperative computed tomography. We evaluated postoperative outcomes and the influence of sarcopenia on short-term outcomes, especially infectious complications. Subsequently, multivariate analysis was used to assess the impact of prognostic factors (including sarcopenia) on postoperative infections.ResultsThe mortality, major complication, and infectious complication rates for all patients were 1.4%, 16.4%, and 47.0%, respectively. Fifty-five patients met the criteria for sarcopenia. Sarcopenia was significantly associated with a higher incidence of in-hospital mortality (P = 0.004) and infectious complications (P < 0.001). In multivariate analyses, sarcopenia (odds ratio = 3.43; P < 0.001), preoperative biliary drainage (odds ratio = 2.20; P = 0.014), blood loss (odds ratio = 1.92; P = 0.048), and soft pancreatic texture (odds ratio = 3.71; P < 0.001) were independent predictors of postoperative infections.ConclusionsSarcopenia is an independent preoperative predictor of infectious complications after PD. Clinical assessment combined with sarcopenia may be helpful for understanding the risk of postoperative outcomes and determining perioperative management strategies.

Sarcopenia is an independent predictor of delayed gastric emptying following pancreaticoduodenectomy: a retrospective study

“…investigated the relationship between pre‐operative skeletal muscle mass and complications after pancreaticoduodenectomy. They found sarcopenia to be independently associated with infectious complications, including CR‐POPF, wound infection, and intra‐abdominal abscess, but found no significant relationship between skeletal muscle mass and DGE . In the current study, we found an independent association between pre‐operative sarcopenia and post‐pancreaticoduodenectomy DGE; however, the mechanisms by which sarcopenia increases the risk of DGE are unclear.…”

“…However, the mechanisms by which sarcopenia increases the risk of post‐operative morbidity are unclear. Some studies have specifically evaluated the relationship between pre‐operative sarcopenia and post‐pancreaticoduodenectomy DGE . Takagi et al .…”

“…Some studies have investigated the relationship between pre‐operative nutritional markers and post‐pancreaticoduodenectomy DGE . In these studies, serum albumin concentration was used as a pre‐operative nutritional marker and found to have no relationship with DGE.…”

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

“…All of the image analysis was based on CT, and the third lumbar vertebra was the most commonly used level. SMI/ TAMA was the most commonly used index, and it was used in 16 studies [11, 13, 19, 21, 23-28, 32, 34, 36-39], with SBI in 2 studies [40,42], PMI/TPA in 7 studies [12,20,22,[29][30][31]33], MA/RA in 5 studies [13,24,37,38,41], IMAC in 4 studies [20,27,31,33], HUAC in 1 study [35], LPMA in 1 study [14], and TPV in 1 study [12] ( Table 3).…”

The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis

“…Surgical procedures (Table 1), operative time, intraoperative blood loss, and blood transfusion were recorded as intraoperative outcomes. Details of the surgical techniques of hepatectomy, pancreaticoduodenectomy, and hepatopancreatectomy have been reported previously [11][12][13][14]. At our center, age is not recognized as a contraindication.…”