Top

Published in:

01-10-2009 | Original Article

The Role of “Fatty Pancreas” and of BMI in the Occurrence of Pancreatic Fistula After Pancreaticoduodenectomy

Authors: Edoardo Rosso, Selenia Casnedi, Patrick Pessaux, Elie Oussoultzoglou, Fabrizio Panaro, Mahfud Mahfud, Daniel Jaeck, Philippe Bachellier

Published in: Journal of Gastrointestinal Surgery | Issue 10/2009

Abstract

Introduction

Pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is still a serious complication. We hypothesized that the amount of fatty tissue in the pancreatic parenchyma could be associated with the occurrence of PF after PD with pancreatogastrostomy.

Material and methods

From January 2004 to December 2006, 111 consecutive patients underwent PD with pancreatogastrostomy. The microscopic amount of fatty tissue in the pancreas was evaluated.

Results

The morbidity and mortality rates were 35.1% and 1.8%, respectively. PF occurred in 10.8% (n = 12). PF was of grade A in nine, grade B in two, and grade C in one patient. Univariate analysis showed that a body mass index (BMI) > 25 (P = 0.035), a soft pancreatic parenchyma (P = <0.003), a pancreatic duct size <3 mm (P = 0.015), and a fatty infiltration of the pancreas of more than 10% (P = 0.0003) were associated with the occurrence of PF. The advanced age (P = 0.049) and the BMI (P < 0.0001) were significantly associated with the presence of >10% of pancreatic fat.

Conclusions

A pancreatic fatty infiltration of the pancreas over 10% constitutes a risk factor for PF after PD. Age and BMI are useful preoperative predictors of the percentage of pancreatic fat.

Fukuda S, Oussoultzoglou E, Bachellier P, Rosso E, Nakano H, Audet M, Jaeck D. Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma. Arch Surg. 2007;142:172–179.PubMedCrossRef

Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 2006;10:1199–1210.PubMedCrossRef

McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007;246:246–253.PubMedCrossRef

Satoi S, Takai S, Matsui Y, Terakawa N, Iwaki R, Fukui J, Yanagimoto H, Takahashi K, Toyokawa H, Araki H, Kwon AH, Kamiyama Y. Less morbidity after pancreaticoduodenectomy of patients with pancreatic cancer. Pancreas 2006;33:45–52.PubMedCrossRef

Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244:10–15.PubMedCrossRef

Rosso E, Bachellier P, Oussoultzoglou E, Scurtu R, Meyer N, Nakano H, Verasay G, Jaeck D. Toward zero pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. Am J Surg 2006;191:726–732.PubMedCrossRef

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761–768.PubMedCrossRef

Scurtu R, Bachellier P, Oussoultzoglou E, Rosso E, Maroni R, Jaeck D. Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg 2006;10:813–822.PubMedCrossRef

Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C, Traverso LW, Pancreatic Anastomotic Leak Study Group. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg 2007;11:1451–1458.PubMedCrossRef

10.

Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg 2007;245:443–451.PubMedCrossRef

11.

Aranha GV, Aaron JM, Shoup M, Pickleman J. Current management of pancreatic fistula after pancreaticoduodenectomy. Surgery 2006;140:561–568.PubMedCrossRef

12.

Yang YM, Tian XD, Zhuang Y, Wang WM, Wan YL, Huang YT. Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol 2005;11(16):2456–2461.PubMed

13.

Oussoultzoglou E, Bachellier P, Bigourdan JM, Weber JC, Nakano H, Jaeck D. Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy. Arch Surg 2004;139:327–335.PubMedCrossRef

14.

Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg 2003;237:509–514.PubMedCrossRef

15.

16.

House MG, Fong Y, Arnaoutakis DJ, Sharma R, Winston CB, Protic M, Gonen M, Olson SH, Kurtz RC, Brennan MF, Allen PJ. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 2008;12:270–278.PubMedCrossRef

17.

Okabayashi T, Kobayashi M, Nishimori I, Sugimoto T, Onishi S, Hanazaki K. Risk factors, predictors and prevention of pancreatic fistula formation after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg 2007;14:557–563.PubMedCrossRef

18.

Williams TK, Rosato EL, Kennedy EP, Chojnacki KA, Andrel J, Hyslop T, Doria C, Sauter PK, Bloom J, Yeo CJ, Berger AC. Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg 2009;208:210–217.PubMedCrossRef

19.

Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 2007;246:425–433.PubMedCrossRef

20.

Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ, Nakeeb A, Zyromski NJ, Lillemoe KD. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg 2007;246:1058–1064.PubMedCrossRef

21.

Delcore R, Rodriguez FJ, Forster J, Hermreck AS, Thomas JH. Significance of lymph node metastases in patients with pancreatic cancer undergoing curative resection. Am J Surg 1996;172:463–468.PubMedCrossRef

22.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.PubMedCrossRef

23.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.PubMedCrossRef

24.

Bamgbade OA, Rutter TW, Nafiu OO, Dorje P. Postoperative complications in obese and nonobese patients. World J Surg 2007;31:556–560.PubMedCrossRef

25.

Sledzianowski JF, Duffas JP, Muscari F, Suc B, Fourtanier F. Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy. Surgery 2005;137:180–185.PubMedCrossRef

26.

Saisho Y, Butler AE, Meier JJ, Monchamp T, Allen-Auerbach M, Rizza RA, Butler PC. Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type-2 diabetes. Clin Anat 2007;20:933–942.PubMedCrossRef

27.

Olsen TS. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Pathol Microbiol Scan 1978;86A:367–373.

28.

Fiorini RN, Kirtz J, Periyasamy B, Evans Z, Haines JK, Cheng G, Polito C, Rodwell D, Shafizadeh SF, Zhou X, Campbell C, Birsner J, Schmidt M, Lewin D, Chavin KD. Development of an unbiased method for the estimation of liver steatosis. Clin Transplant 2004;18:700–706.PubMedCrossRef

29.

Katz DS, Hines J, Math KR, Nardi PM, Mindelzun RE, Lane MJ. Using CT to reveal fat-containing abnormalities of the pancreas. AJR Am J Roentgenol 1999;172:393–396.PubMed

30.

Jaster R, Emmrich J. Crucial role of fibrogenesis in pancreatic diseases. Best Pract Res Clin Gastroentero. 2008;22:17–29.CrossRef

Title: The Role of “Fatty Pancreas” and of BMI in the Occurrence of Pancreatic Fistula After Pancreaticoduodenectomy
Authors: Edoardo Rosso
Selenia Casnedi
Patrick Pessaux
Elie Oussoultzoglou
Fabrizio Panaro
Mahfud Mahfud
Daniel Jaeck
Philippe Bachellier
Publication date: 01-10-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-0974-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Role of “Fatty Pancreas” and of BMI in the Occurrence of Pancreatic Fistula After Pancreaticoduodenectomy

Abstract

Introduction

Material and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Material and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2009

S100A4 mRNA is a Diagnostic and Prognostic Marker in Pancreatic Carcinoma

Duodenal-Jejunal Exclusion Improves Glucose Tolerance in the Diabetic, Goto-Kakizaki Rat by a GLP-1 Receptor-Mediated Mechanism

“Above Average” SSAT Presidential Address 2009

Does a 48-Hour Rule Predict Outcomes in Patients with Acute Sigmoid Diverticulitis?

Effective Treatment of Advanced Colorectal Cancer by Rapamycin and 5-FU/Oxaliplatin Monitored by TIMP-1

Anti-ERBB2 sh-RNA Suppress Both Cell Growth and Tumor Growth in ERBB2-Overexpressing Upper Gastrointestinal Adenocarcinomas