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Preoperative Predictors for Complications after Pancreaticoduodenectomy: Impact of BMI and Body Fat Distribution

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The purpose of this study was to examine the preoperative patient and radiographic factors that are associated with operative morbidity after pancreaticoduodenectomy.

Material and Methods

Patient characteristics and preoperative radiographic findings and their association with postoperative complications after pancreaticoduodenectomy were analyzed for 356 patients with pancreatic adenocarcinoma who underwent resection between 2000 and 2005.

Results

Postoperative complications developed in 135 patients (38%). The most common complications were pancreatic fistula/abscess (15%), wound infection (14%), and delayed gastric emptying (4%). On multivariate analysis, the only preoperative radiographic factors associated with having any postoperative complication were the absence of pancreatic atrophy and the extent of central obesity determined by the thickness of retrorenal visceral fat (VF). Complications occurred in 51% of patients with VF ≥ 2 cm, compared to 31% of patients with VF < 2 cm, p < 0.001. Postoperatively, pancreatic fistula developed in 24% of patients with VF ≥ 2 cm and in only 10% of patients with VF < 2 cm, p = 0.01. Wound infections occurred in 21% of the patients with body mass index greater than or equal to 30 kg/m2 compared to 12% of the nonobese patients, p = 0.03.

Conclusions

Generalized obesity is associated with postoperative wound infections after pancreaticoduodenectomy. The degree of visceral fat on preoperative cross-sectional imaging is associated with significantly higher rates of overall complications and pancreatic fistula.

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Authors and Affiliations

  1. Department of Surgery, H-1223, Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA

    Michael G. House, Yuman Fong, Dean J. Arnaoutakis, Rohit Sharma, Mladjan Protic, Murray F. Brennan & Peter J. Allen

  2. Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA

    Corinne B. Winston

  3. Department of Gastroenterology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA

    Robert C. Kurtz

  4. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA

    Mithat Gonen

  5. Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Sara H. Olson

Authors
  1. Michael G. House
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  2. Yuman Fong
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  3. Dean J. Arnaoutakis
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  4. Rohit Sharma
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  6. Mladjan Protic
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  7. Mithat Gonen
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  8. Sara H. Olson
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  9. Robert C. Kurtz
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  10. Murray F. Brennan
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  11. Peter J. Allen
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Correspondence to Peter J. Allen.

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House, M.G., Fong, Y., Arnaoutakis, D.J. et al. Preoperative Predictors for Complications after Pancreaticoduodenectomy: Impact of BMI and Body Fat Distribution. J Gastrointest Surg 12, 270–278 (2008). https://doi.org/10.1007/s11605-007-0421-7

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  • DOI: https://doi.org/10.1007/s11605-007-0421-7

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