Visceral adipose tissue and skeletal muscle index distribution predicts development of severe pancreatic fistula after pancreaticoduodenectomy

Abstract

laparoscopic ultrasound (LUS) and fluorescence imaging (LFI). Methods: All patients planned to undergo resection of pancreatic or periampullary cancer were included prospectively. Patients received an intravenous infusion of 10 mg indocyanine green (ICG) 1 or 2 days before surgery to allow LFI of potential liver metastases. Suspect lesions were analyzed via biopsy or resection. Results: A total of 21 patients is currently included. Suspect lesions were identified in 3 patients: liver metastases (identified by inspection, LFI and LUS), peritoneal metastases (inspection) and a lesion that appeared to be benign afterwards (LUS). Quality of LFI was good in 8/13 (62%) patients dosed 1 day and in 6/7 (86%) patients dosed 2 days prior to surgery. Eighteen patients had no signs of irresectability during SL; the primary tumor was resected in 16 patients. Two out of 8 patients with a follow-up >6 months after resection developed liver metastases. Conclusion: Despite current preoperative imaging modalities, metastases are still identified during surgery. The current study shows limited added value of LUS and LFI during SL in pancreatic cancer patients. A total of 25 patients will be included and additional follow-up will be available for presentation.

The effects of sarcopenia and sarcopenic obesity after pancreaticoduodenectomy in patients with pancreatic head cancer

“…Previous studies have suggested that SO is a risk factor for occurrence of major complications or CR-POPF after pancreas resection. 16,17,27 In this study, SO was a strong risk factor for development of CR-POPF. This finding did not differ from that of a recent study stating that SO adversely affected the outcome of pancreatic surgery.…”

“…Recently, a few studies have reported that sarcopenia and SO affect postoperative outcomes after PD. 16,17,[25][26][27] In this study, sarcopenia and sarcopenic obesity were measured with an easy, low-cost method using a reliable program developed by this institute. Compared to the limitations of previous studies, the PHC patients who underwent a PD operation were included in this study to uniformly define the disease and surgical procedure and were numbered more than 500.…”

“…15 Excess adiposity that may generate significant adverse health effects, such as hypertension, dyslipidaemia, and insulin resistance, leads to similar surgical complications. 16,17 A few studies have revealed that SO is a risk factor for CR-POPF. However, these studies have included only a small number of patients and various diseases in periampullary cancer.…”

“…However, these studies have included only a small number of patients and various diseases in periampullary cancer. 17,18 The purpose of this study was to identify the relationship between postoperative complications, especially CR-POPF and sarcopenia or SO after PD in pancreatic head cancer (PHC). This study also examined the effects of sarcopenia and sarcopenic obesity on OS in PHC.…”

Measurement of Body Composition in Pancreatic Cancer: A Systematic Review, Meta-Analysis, and Recommendations for Future Study Design

“…Studies utilizing LSMI as a proxy for sarcopenia either applied a variety of previously reported, pre-defined gender-specific cut-offs, or defined their individual population-specific cut-offs, such as the lowest gender-specific quartile or median level. Five studies applied previously reported gender- and BMI-specific cut-offs [24, 26, 28, 35, 45]. A number of studies included the assessment of muscle density assessment when evaluating body composition [18, 21, 32, 33, 39], while three studies considered the impact of co-existing obesity/adiposity [26, 28, 35].…”