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

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Disclosure

The authors disclose no conflicts of interest.

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Authors and Affiliations

  1. Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy

    Nicolò Pecorelli MD & Marco Braga MD

  2. Pancreatic Surgery Unit, Humanitas University, Humanitas Research Hospital, Rozzano, Italy

    Giovanni Capretti MD & Alessandro Zerbi MD

  3. Unit of Hepato-biliary-pancreatic Surgery, School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy

    Marta Sandini MD & Luca Gianotti MD, ScD

  4. Department of Radiology, Vita-Salute San Raffaele University Hospital, Milan, Italy

    Anna Damascelli MD, Giulia Cristel MD & Francesco De Cobelli MD

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  1. Nicolò Pecorelli MD
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Corresponding author

Correspondence to Nicolò Pecorelli MD.

Electronic supplementary material

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Supplementary material 1 (TIFF 8365 kb)

Supplementary Material 1. CT scan at the third lumbar vertebra level in a sarcopenic obese male patient included in the study. (a) unprocessed imaging; (b) processed imaging. Subcutaneous fat area (SFA) is highlighted in yellow, total abdominal muscle area (TAMA) in red, and visceral fat area (VFA) in green. SFA was 299 cm2, TAMA 33 cm2/m2, VFA 165 cm2. His VFA/TAMA ratio was 5.0.

Supplementary material 2 (DOCX 107 kb)

Supplementary Material 2. Definition of postoperative complications used in the study.

Supplementary material 3 (TIFF 3939 kb)

Supplementary Material 3. Receiver operating characteristic curve of final multivariate model for failure to rescue.

Supplementary material 4 (DOCX 21 kb)

Supplementary Material 4. Univariate and multivariate logistic regression analysis of potential predictors associated with failure to rescue after pancreaticoduodenectomy, entering visceral fat area instead of visceral adipose tissue-to-skeletal muscle ratio in the multivariate model.

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Pecorelli, N., Capretti, G., Sandini, M. et al. Impact of Sarcopenic Obesity on Failure to Rescue from Major Complications Following Pancreaticoduodenectomy for Cancer: Results from a Multicenter Study. Ann Surg Oncol 25, 308–317 (2018). https://doi.org/10.1245/s10434-017-6216-5

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