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Predictive value of sarcopenia and visceral obesity for postoperative pancreatic fistula after pancreaticoduodenectomy analyzed on clinically acquired CT and MRI

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objective

To evaluate predictive values of sarcopenia and visceral obesity measured from preoperative CT/MRIs for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy in patients with periampullary malignancies.

Methods

From the prospectively constructed surgical registry, we included adult patients treated with pancreaticoduodenectomy. Based on CT/MRIs, body morphometric analysis was performed to evaluate the visceral obesity and sarcopenia, based on the areas of visceral fat and skeletal muscle measured at the L3 vertebrae level. We retrieved various perioperative factors from registry. As outcomes of postoperative complications, we evaluated POPF and major complications based on the Clavien-Dindo classification. Multivariate logistic regression analyses were performed.

Results

From a total of 284 patients (163 males, 121 females) who met the inclusion/exclusion criteria, POPF, major complications, and 60-day mortality occurred in 52 (18.3%), 34 (12.0%), and 6 (2.1%), respectively. Sarcopenia and visceral obesity were noted in 123 (75.5%) and 66 (40.5%) of men and 68 (56.2%) and 53 (43.8%) of women, respectively. Combination of sarcopenia and obesity (sarcopenic obesity) was noted in 31.9% (52/163) of men and in 26.4% (32/121) of women. In multivariate logistic regression analyses, sarcopenic obesity was the only independent predictor for POPF (OR 2.65, 95% CI 1.43–4.93), and the vascular resection during pancreaticoduodenectomy was the only independent predictor for severe complications (OR 3.75, 95% CI 1.61–8.70).

Conclusion

Sarcopenic obesity might be highly predictive for POPF. Body morphometric analysis in preoperative CT/MRI combined with assessment of perioperative clinical features may help to identify high-risk patients and determine perioperative management strategies.

Key Points

• Sarcopenic obesity might be predictive for postoperative pancreatic fistula after pancreaticoduodenectomy.

• The vascular resection during pancreaticoduodenectomy might be predictive of major complications.

• Body morphometric analysis might be helpful for identifying high-risk patients.

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Abbreviations

ASA:

American Society of Anesthesiologists

BIA:

Bioelectrical impedance analysis

BMI:

Body mass index

CT:

Computed tomography

DEXA:

Dual energy x-ray absorptiometry

EWGSOP:

European working group on sarcopenia in older people

HU:

Hounsfield unit

ISGPR:

International Study Group on Pancreatic Fistula

MPD:

Main pancreatic duct

MRCP:

Magnetic resonance cholangiopancreatography

PACS:

Picture archiving and communication system

POPF:

Postoperative pancreatic fistula

SFA:

Subcutaneous fat area

SI:

Signal intensity

TAMA:

Total abdominal muscle area

VFA:

Visceral fat area

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Funding

This research was supported by a grant from Guerbet (No. GK-XTX-2017-34) and a grant (No. HI18C1216) from the Korea Health Industry Development Institute (KHIDI).

Author information

Author notes

  1. Minji Jang and Hyung Woo Park contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea

    Minji Jang, Jimi Huh, Jong Hwa Lee & Yoong Ki Jeong

  2. Department of Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea

    Hyung Woo Park & Yang Won Nah

  3. Department of Radiology, Ajou University School of Medicine & Graduate School of Medicine, Ajou University Medical Center, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea

    Jimi Huh

  4. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Jisuk Park & Kyung Won Kim

Authors
  1. Minji Jang
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Corresponding author

Correspondence to Jimi Huh.

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Guarantor

The scientific guarantor of this publication is Jimi Huh.

Conflict of interest

J.H. is a recipient of the grant from Guerbet.

K.W.K. is a recipient of the grant from the Korea Health Industry Development Institute (KHIDI).

The other authors have no conflict of interest.

Statistics and biometry

One author (Kyung Won Kim) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Jang, M., Park, H.W., Huh, J. et al. Predictive value of sarcopenia and visceral obesity for postoperative pancreatic fistula after pancreaticoduodenectomy analyzed on clinically acquired CT and MRI. Eur Radiol 29, 2417–2425 (2019). https://doi.org/10.1007/s00330-018-5790-7

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  • DOI: https://doi.org/10.1007/s00330-018-5790-7

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