Annals of Surgical Oncology

, Volume 25, Issue 1, pp 308–317 | Cite as

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

  • Nicolò PecorelliEmail author
  • Giovanni Capretti
  • Marta Sandini
  • Anna Damascelli
  • Giulia Cristel
  • Francesco De Cobelli
  • Luca Gianotti
  • Alessandro Zerbi
  • Marco Braga
Pancreatic Tumors



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.


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.


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.


Sarcopenic obesity, low preoperative physical status, and occurrence of pancreatic fistula are associated with significantly higher risk of FTR from major complications after PD.



The authors disclose no conflicts of interest.

Supplementary material

10434_2017_6216_MOESM1_ESM.tiff (8.2 mb)
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.
10434_2017_6216_MOESM2_ESM.docx (107 kb)
Supplementary material 2 (DOCX 107 kb) Supplementary Material 2. Definition of postoperative complications used in the study.
10434_2017_6216_MOESM3_ESM.tif (3.8 mb)
Supplementary material 3 (TIFF 3939 kb) Supplementary Material 3. Receiver operating characteristic curve of final multivariate model for failure to rescue.
10434_2017_6216_MOESM4_ESM.docx (21 kb)
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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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Nicolò Pecorelli
    • 1
    Email author
  • Giovanni Capretti
    • 2
  • Marta Sandini
    • 3
  • Anna Damascelli
    • 4
  • Giulia Cristel
    • 4
  • Francesco De Cobelli
    • 4
  • Luca Gianotti
    • 3
  • Alessandro Zerbi
    • 2
  • Marco Braga
    • 1
  1. 1.Division of Pancreatic Surgery, Pancreas Translational & Clinical Research CenterVita-Salute San Raffaele University, San Raffaele Scientific InstituteMilanItaly
  2. 2.Pancreatic Surgery Unit, Humanitas UniversityHumanitas Research HospitalRozzanoItaly
  3. 3.Unit of Hepato-biliary-pancreatic Surgery, School of Medicine and Surgery, Milano-Bicocca UniversitySan Gerardo HospitalMonzaItaly
  4. 4.Department of RadiologyVita-Salute San Raffaele University HospitalMilanItaly

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