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European Radiology
Published in: European Radiology 5/2019

01-05-2019 | Hepatobiliary-Pancreas

Predictive value of sarcopenia and visceral obesity for postoperative pancreatic fistula after pancreaticoduodenectomy analyzed on clinically acquired CT and MRI

Authors: Minji Jang, Hyung Woo Park, Jimi Huh, Jong Hwa Lee, Yoong Ki Jeong, Yang Won Nah, Jisuk Park, Kyung Won Kim

Published in: European Radiology | Issue 5/2019

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Abstract

Objective

To evaluate predictive values of sarcopenia and visceral obesity measured from preoperative CT/MRIs for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy in patients with periampullary malignancies.

Methods

From the prospectively constructed surgical registry, we included adult patients treated with pancreaticoduodenectomy. Based on CT/MRIs, body morphometric analysis was performed to evaluate the visceral obesity and sarcopenia, based on the areas of visceral fat and skeletal muscle measured at the L3 vertebrae level. We retrieved various perioperative factors from registry. As outcomes of postoperative complications, we evaluated POPF and major complications based on the Clavien-Dindo classification. Multivariate logistic regression analyses were performed.

Results

From a total of 284 patients (163 males, 121 females) who met the inclusion/exclusion criteria, POPF, major complications, and 60-day mortality occurred in 52 (18.3%), 34 (12.0%), and 6 (2.1%), respectively. Sarcopenia and visceral obesity were noted in 123 (75.5%) and 66 (40.5%) of men and 68 (56.2%) and 53 (43.8%) of women, respectively. Combination of sarcopenia and obesity (sarcopenic obesity) was noted in 31.9% (52/163) of men and in 26.4% (32/121) of women. In multivariate logistic regression analyses, sarcopenic obesity was the only independent predictor for POPF (OR 2.65, 95% CI 1.43–4.93), and the vascular resection during pancreaticoduodenectomy was the only independent predictor for severe complications (OR 3.75, 95% CI 1.61–8.70).

Conclusion

Sarcopenic obesity might be highly predictive for POPF. Body morphometric analysis in preoperative CT/MRI combined with assessment of perioperative clinical features may help to identify high-risk patients and determine perioperative management strategies.

Key Points

• Sarcopenic obesity might be predictive for postoperative pancreatic fistula after pancreaticoduodenectomy.
• The vascular resection during pancreaticoduodenectomy might be predictive of major complications.
• Body morphometric analysis might be helpful for identifying high-risk patients.
Appendix
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Metadata
Title
Predictive value of sarcopenia and visceral obesity for postoperative pancreatic fistula after pancreaticoduodenectomy analyzed on clinically acquired CT and MRI
Authors
Minji Jang
Hyung Woo Park
Jimi Huh
Jong Hwa Lee
Yoong Ki Jeong
Yang Won Nah
Jisuk Park
Kyung Won Kim
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5790-7

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