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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2018

01-01-2018 | Pancreatic Tumors

Impact of Sarcopenic Obesity on Failure to Rescue from Major Complications Following Pancreaticoduodenectomy for Cancer: Results from a Multicenter Study

Authors: Nicolò Pecorelli, MD, Giovanni Capretti, MD, Marta Sandini, MD, Anna Damascelli, MD, Giulia Cristel, MD, Francesco De Cobelli, MD, Luca Gianotti, MD, ScD, Alessandro Zerbi, MD, Marco Braga, MD

Published in: Annals of Surgical Oncology | Issue 1/2018

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Abstract

Background

Failure to rescue (FTR) is a quality-of-care indicator in pancreatic surgery, but may also identify patients who may not tolerate major postoperative complications despite being treated with best available care. Previous studies found that high visceral adipose tissue-to-skeletal muscle ratio is associated with poor outcomes following pancreaticoduodenectomy (PD). The aim of the study is to assess the impact of sarcopenic obesity on occurrence of FTR from major complications in cancer patients undergoing PD.

Methods

Prospectively collected data from three high-volume hospitals were reviewed. Total abdominal muscle area (TAMA) and visceral fat area (VFA) were assessed at preoperative staging computed tomography scan. Sarcopenic obesity was defined as high VFA/TAMA ratio. FTR was defined as postoperative mortality following major complication.

Results

120 patients with major complications were included. FTR occurred in 23 (19.2%) patients. The “seminal” complications leading to FTR were pancreatic or biliary fistula-related sepsis (n = 14), postoperative pancreatic fistula (POPF)-related hemorrhage (n = 5), and duodenojejunal anastomosis leak-related sepsis (n = 1). On univariate analysis, older age [odds ratio (OR) 3.5, p = 0.034], American Society of Anesthesiologists (ASA) score 3+ (OR 4.2, p = 0.005), cardiovascular disease (OR 3.3, p = 0.013), low serum albumin (OR 2.6, p = 0.042), sarcopenic obesity (OR 4.2, p = 0.009), POPF (OR 3.1, p = 0.027), and cardiorespiratory complications (OR 3.7, p = 0.011) were significantly associated with FTR. On multivariate analysis, sarcopenic obesity [OR 5.7, 95% confidence interval (CI) 1.6–20.7, p = 0.008], ASA score 3+ (OR 4.1, 95% CI 1.2–14.3, p = 0.025), and pancreatic fistula (OR 3.2, 95% CI 1.0–10.2, p = 0.045) were independently associated with FTR.

Conclusion

Sarcopenic obesity, low preoperative physical status, and occurrence of pancreatic fistula are associated with significantly higher risk of FTR from major complications after PD.
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Metadata
Title
Impact of Sarcopenic Obesity on Failure to Rescue from Major Complications Following Pancreaticoduodenectomy for Cancer: Results from a Multicenter Study
Authors
Nicolò Pecorelli, MD
Giovanni Capretti, MD
Marta Sandini, MD
Anna Damascelli, MD
Giulia Cristel, MD
Francesco De Cobelli, MD
Luca Gianotti, MD, ScD
Alessandro Zerbi, MD
Marco Braga, MD
Publication date
01-01-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 1/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6216-5

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