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Journal of Gastrointestinal Surgery

, Volume 16, Issue 8, pp 1478–1486 | Cite as

Impact of Sarcopenia on Outcomes Following Resection of Pancreatic Adenocarcinoma

  • Peter Peng
  • Omar Hyder
  • Amin Firoozmand
  • Peter Kneuertz
  • Richard D. Schulick
  • Donghang Huang
  • Martin Makary
  • Kenzo Hirose
  • Barish Edil
  • Michael A. Choti
  • Joseph Herman
  • John L. Cameron
  • Christopher L. Wolfgang
  • Timothy M. PawlikEmail author
Original Article

Abstract

Introduction

Assessing patient-specific risk factors for long-term mortality following resection of pancreatic adenocarcinoma can be difficult. Sarcopenia—the measurement of muscle wasting—may be a more objective and comprehensive patient-specific factor associated with long-term survival.

Methods

Total psoas area (TPA) was measured on preoperative cross-sectional imaging in 557 patients undergoing resection of pancreatic adenocarcinoma between 1996 and 2010. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on 90-day, 1-year, and 3-year mortality was assessed relative to other clinicopathological factors.

Results

Mean patient age was 65.7 years and 53.1 % was male. Mean TPA among men (611 mm2/m2) was greater than among women (454 mm2/m2). Surgery involved pancreaticoduodenectomy (86.0 %) or distal pancreatectomy (14.0 %). Mean tumor size was 3.4 cm; 49.9 % and 88.5 % of patients had vascular and perineural invasion, respectively. Margin status was R0 (59.0 %) and 77.7 % patients had lymph node metastasis. Overall 90-day mortality was 3.1 % and overall 1- and 3-year survival was 67.9 % and 35.7 %, respectively. Sarcopenia was associated with increased risk of 3-year mortality (HR = 1.68; P < 0.001). Tumor-specific factors such as poor differentiation on histology (HR = 1.75), margin status (HR = 1.66), and lymph node metastasis (HR = 2.06) were associated with risk of death at 3-years (all P < 0.001). After controlling for these factors, sarcopenia remained independently associated with an increased risk of death at 3 years (HR = 1.63; P < 0.001).

Conclusions

Sarcopenia was a predictor of survival following pancreatic surgery, with sarcopenic patients having a 63 % increased risk of death at 3 years. Sarcopenia was an objective measure of patient frailty that was strongly associated with long-term outcome independent of tumor-specific factors.

Keywords

Sarcopenia Pancreas surgery Morbidity Mortality Outcomes 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Peter Peng
    • 1
  • Omar Hyder
    • 1
  • Amin Firoozmand
    • 1
  • Peter Kneuertz
    • 1
  • Richard D. Schulick
    • 1
  • Donghang Huang
    • 1
  • Martin Makary
    • 1
  • Kenzo Hirose
    • 1
  • Barish Edil
    • 1
  • Michael A. Choti
    • 1
  • Joseph Herman
    • 2
  • John L. Cameron
    • 1
  • Christopher L. Wolfgang
    • 1
  • Timothy M. Pawlik
    • 1
    • 3
    Email author
  1. 1.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Radiation OncologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA

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