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Pancreatic Fat and Body Composition Measurements by Computed Tomography are Associated with Pancreatic Fistula After Pancreatectomy

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

Abstract

Objectives

Postoperative pancreatic fistula (POPF) is the most threatening complication after pancreatectomy. This study aimed to directly assess pancreatic fatty infiltration with preoperative computed tomography (CT) imaging and to investigate whether a preoperative analysis of patient variables, including CT characteristics and clinical factors, can predict POPF.

Methods

We enrolled 150 consecutive patients who underwent curative pancreatectomy. Radiographic factors, including pancreatic fat volume, were measured using preoperative CT imaging and the predictive factors were explored using univariate and multivariate analyses.

Results

POPF developed in 30 patients (20.0%). The ratio of pancreatic fat (RPF) ≥ 4.83% was associated with a risk of POPF, high body mass index (BMI), and obese body habitus. Patients with POPF were significantly more likely to have high BMI (≥ 25 kg/m2), obese body habitus, and an RPF ≥ 4.83% than patients without POPF. In the multivariate analysis, visceral fat area/skeletal muscle index (VFA/SMI) ≥ 1.94 (odds ratio [OR] 4.28, 95% confidence interval [CI] 1.43–12.9, p = 0.0095) was the sole independent predictive factor for POPF. For patients with a soft pancreas, VFA/SMI ≥ 1.94 (OR 5.67, 95% CI 2.05–15.7, p = 0.0008) was again the sole independent predictive factor for POPF.

Conclusion

Preoperative CT images can examine pancreatic fatty infiltration, and patients who had POPF were significantly associated with a high RPF. Among several parameters, VFA/SMI was the only independent predictive factor for clinically relevant POPF. Preoperative evaluation of these body composition variables and the pancreatic configuration could be useful for predicting POPF.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

    Katsuhito Tanaka MD, Suguru Yamada MD, PhD, FACS, Fuminori Sonohara MD, PhD, Hideki Takami MD, PhD, Masamichi Hayashi MD, PhD, FACS, Mitsuro Kanda MD, PhD, FACS, Daisuke Kobayashi MD, PhD, Chie Tanaka MD, PhD, Goro Nakayama MD, PhD, Masahiko Koike MD, PhD, Michitaka Fujiwara MD, PhD & Yasuhiro Kodera MD, PhD, FACS

Authors
  1. Katsuhito Tanaka MD
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  2. Suguru Yamada MD, PhD, FACS
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  3. Fuminori Sonohara MD, PhD
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  4. Hideki Takami MD, PhD
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  8. Chie Tanaka MD, PhD
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Correspondence to Suguru Yamada MD, PhD, FACS.

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Tanaka, K., Yamada, S., Sonohara, F. et al. Pancreatic Fat and Body Composition Measurements by Computed Tomography are Associated with Pancreatic Fistula After Pancreatectomy. Ann Surg Oncol 28, 530–538 (2021). https://doi.org/10.1245/s10434-020-08581-9

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  • DOI: https://doi.org/10.1245/s10434-020-08581-9

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