Elsevier

Surgery

Volume 152, Issue 3, Supplement, September 2012, Pages S81-S88
Surgery

Cachexia but not obesity worsens the postoperative outcome after pancreatoduodenectomy in pancreatic cancer

https://doi.org/10.1016/j.surg.2012.05.028Get rights and content

Background

Prognosis after pancreatoduodenectomy for pancreatic cancer is determined by tumor characteristics, completeness of resection, and patient's comorbidity. Our aim was to assess the effects of body mass and fat distribution on the postoperative course after pancreatoduodenectomy.

Methods

Of 2,968 pancreatic resections, 408 patients with primary pancreatic adenocarcinoma who underwent pancreatoduodenectomy and of whom cross sectional images were available were identified and followed-up in a prospective database. Preoperative computed tomographic or magnetic resonance imaging scans were analyzed for abdominal wall fat, hip girdle fat, visceral fat, and abdominal depth. Peri- and postoperative parameters, including preoperative unintentional weight loss, cachexia-associated serum parameters, nonoperative and operative complications, and mortality and long-term survival were evaluated and correlated with body mass index and fat distribution.

Results

Patients with low body mass index had a greater 90-day mortality (P = .048) and a trend toward greater complication rates and in-hospital mortality, despite a greater comorbidity in obese patients with a higher body mass index. Accordingly, patients with large amounts of abdominal wall fat had fewer intra-abdominal abscesses (P = .047), lower in-hospital (P = .019) and 90-day mortality rates (P = .007), and better long-term survival (P = .016).

Conclusion

In pancreatic cancer, underweight but not obese patients have a poor outcome after pancreatoduodenectomy. This observation emphasizes the need for pre- and perioperative therapeutic improvements in the setting of pancreatic cancer–associated cachexia.

Section snippets

Patients

Of 2,968 consecutive pancreatic resections performed at the Department of General Surgery of the University of Heidelberg between October 2001 and July 2010, 794 were pancreatoduodenectomies for primary pancreatic adenocarcinoma. Of those, 408 patients whose preoperative computed tomographic (CT) or magnetic resonance imaging (MRI) scans were available in the electronic radiologic database were identified. Patients with incomplete CT or MRI scans that did not allow the evaluation of body fat

Patient and tumor data

Fifty-eight percent of patients were male, and 42% were female. The mean age of the study cohort was 65.2 years (range, 40–88), the mean body weight was 72 kg (range, 42–140), and the mean BMI was 24.6 (range, 15.1–48.4; Table). The mean AWF thickness was 22.5 mm (range, 1–73), and cut-off points for statistical analysis were set at 20 and 25 mm. Three size-adjusted subgroups were therefore created. The mean HGF thickness was 48 mm (range, 5–114) with subgroup size–calibrating cut-off points at

Discussion

The increasing prevalence of obesity is a serious health problem in most Western countries. BMI >30 kg/m2 has been identified as a risk factor for cardiovascular disease and diabetes,25, 26, 27 and has been associated with an increased risk for developing various cancers.28, 29, 30 In addition, increased operative morbidity and mortality rates have been described for several oncologic resections in obese patients.15, 31 In contrast to previous studies, the present analysis from a large center

References (37)

  • K.C. Fearon et al.

    Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis

    Am J Clin Nutr

    (2006)
  • W. Davidson et al.

    Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer

    Clin Nutr

    (2004)
  • M.W. Buchler et al.

    Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy

    Arch Surg

    (2003)
  • A. Richter et al.

    Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience

    World J Surg

    (2003)
  • M.D. Lieberman et al.

    Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy

    Ann Surg

    (1995)
  • D.J. Gouma et al.

    Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume

    Ann Surg

    (2000)
  • J.L. Cameron et al.

    One thousand consecutive pancreaticoduodenectomies

    Ann Surg

    (2006)
  • D. Ljungman et al.

    Cost-utility estimation of surgical treatment of pancreatic carcinoma aimed at cure

    World J Surg

    (2011)
  • Cited by (106)

    View all citing articles on Scopus

    Drs Pausch and Hartwig contributed equally to this manuscript.

    View full text