Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution Journal Article

Authors: House, M. G.; Fong, Y.; Arnaoutakis, D. J.; Sharma, R.; Winston, C. B.; Protic, M.; Gonen, M.; Olson, S. H.; Kurtz, R. C.; Brennan, M. F.; Allen, P. J.
Article Title: Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution
Abstract: BACKGROUND: The purpose of this study was to examine the preoperative patient and radiographic factors that are associated with operative morbidity after pancreaticoduodenectomy. MATERIAL AND METHODS: Patient characteristics and preoperative radiographic findings and their association with postoperative complications after pancreaticoduodenectomy were analyzed for 356 patients with pancreatic adenocarcinoma who underwent resection between 2000 and 2005. RESULTS: Postoperative complications developed in 135 patients (38%). The most common complications were pancreatic fistula/abscess (15%), wound infection (14%), and delayed gastric emptying (4%). On multivariate analysis, the only preoperative radiographic factors associated with having any postoperative complication were the absence of pancreatic atrophy and the extent of central obesity determined by the thickness of retrorenal visceral fat (VF). Complications occurred in 51% of patients with VF > or = 2 cm, compared to 31% of patients with VF < 2 cm, p < 0.001. Postoperatively, pancreatic fistula developed in 24% of patients with VF > or = 2 cm and in only 10% of patients with VF < 2 cm, p = 0.01. Wound infections occurred in 21% of the patients with body mass index greater than or equal to 30 kg/m(2) compared to 12% of the nonobese patients, p = 0.03. CONCLUSIONS: Generalized obesity is associated with postoperative wound infections after pancreaticoduodenectomy. The degree of visceral fat on preoperative cross-sectional imaging is associated with significantly higher rates of overall complications and pancreatic fistula.
Keywords: adult; aged; aged, 80 and over; middle aged; retrospective studies; pancreatic neoplasms; pancreaticoduodenectomy; adenocarcinoma; risk factors; retrospective study; risk factor; postoperative complication; postoperative complications; body mass; body mass index; pancreas tumor; surgical infection; radiography; multivariate analysis; body composition; pancreatic fistula; surgical wound infection; pancreas fistula; abdominal fat
Journal Title: Journal of Gastrointestinal Surgery
Volume: 12
Issue: 2
ISSN: 1091-255X
Publisher: Springer  
Date Published: 2008-01-01
Start Page: 270
End Page: 278
Language: English
DOI: 10.1007/s11605-007-0421-7
PUBMED: 18060467
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 43" - "Export Date: 17 November 2011" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Rama Sharma
    2 Sharma
  2. Murray F Brennan
    750 Brennan
  3. Sara H Olson
    207 Olson
  4. Mithat Gonen
    693 Gonen
  5. Michael Garrett House
    8 House
  6. Mladjan Protic
    1 Protic
  7. Peter Allen
    434 Allen
  8. Yuman Fong
    735 Fong
  9. Corinne B Winston
    26 Winston
  10. Robert C Kurtz
    130 Kurtz