Abstract
Background
It remains unclear whether preoperative body composition may affect the prognosis
of pancreatic cancer patients undergoing surgery. The aim of the present study was
to assess the extent to which preoperative body composition impacts on postoperative
complication severity and survival in patients undergoing pancreatoduodenectomy for
pancreatic ductal adenocarcinoma (PDAC).
Methods
A retrospective cohort study was performed on consecutive patients who underwent pancreatoduodenectomy
with preoperative CT scan imaging available. Body composition parameters including
total abdominal muscle area (TAMA), visceral fat area (VFA), subcutaneous fat area
and liver steatosis (LS) were assessed. Sarcopenic obesity was defined as a high VFA/TAMA
ratio. Postoperative complication burden was evaluated with the comprehensive complication
index (CCI).
Results
Overall, 371 patients were included in the study. At 90 days after surgery, 80 patients
(22%) experienced severe complications. The median CCI was 20.9 (IQR 0–30). At multivariate
linear regression analysis, preoperative biliary drainage, ASA score ≥3, fistula risk
score and sarcopenic obesity (37% increase; 95%CI 0.06–0.74; p = 0.046) were associated to an increase in CCI. Patient characteristics associated
to sarcopenic obesity were older age, male gender and preoperative LS. At a median
follow-up of 25 months (IQR 18–49), median disease-free survival (DFS) was 19 months
(IQR 15–22). At cox-regression analysis, only pathological features were associated
with DFS, while LS and other body composition measures did not show any prognostic
role.
Conclusion
The combination of sarcopenia and visceral obesity was significantly associated with
increased complication severity after pancreatoduodenectomy for cancer. Patients’
body composition did not affect disease free survival after pancreatic cancer surgery.
Keywords
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Article info
Publication history
Published online: February 12, 2023
Accepted:
February 11,
2023
Received:
January 21,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
