Skip to main content

Advertisement

SpringerLink
Log in

The Role of “Fatty Pancreas” and of BMI in the Occurrence of Pancreatic Fistula After Pancreaticoduodenectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is still a serious complication. We hypothesized that the amount of fatty tissue in the pancreatic parenchyma could be associated with the occurrence of PF after PD with pancreatogastrostomy.

Material and methods

From January 2004 to December 2006, 111 consecutive patients underwent PD with pancreatogastrostomy. The microscopic amount of fatty tissue in the pancreas was evaluated.

Results

The morbidity and mortality rates were 35.1% and 1.8%, respectively. PF occurred in 10.8% (n = 12). PF was of grade A in nine, grade B in two, and grade C in one patient. Univariate analysis showed that a body mass index (BMI) > 25 (P = 0.035), a soft pancreatic parenchyma (P = <0.003), a pancreatic duct size <3 mm (P = 0.015), and a fatty infiltration of the pancreas of more than 10% (P = 0.0003) were associated with the occurrence of PF. The advanced age (P = 0.049) and the BMI (P < 0.0001) were significantly associated with the presence of >10% of pancreatic fat.

Conclusions

A pancreatic fatty infiltration of the pancreas over 10% constitutes a risk factor for PF after PD. Age and BMI are useful preoperative predictors of the percentage of pancreatic fat.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Fukuda S, Oussoultzoglou E, Bachellier P, Rosso E, Nakano H, Audet M, Jaeck D. Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma. Arch Surg. 2007;142:172–179.

    Article  PubMed  Google Scholar 

  2. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 2006;10:1199–1210.

    Article  PubMed  Google Scholar 

  3. McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007;246:246–253.

    Article  PubMed  Google Scholar 

  4. Satoi S, Takai S, Matsui Y, Terakawa N, Iwaki R, Fukui J, Yanagimoto H, Takahashi K, Toyokawa H, Araki H, Kwon AH, Kamiyama Y. Less morbidity after pancreaticoduodenectomy of patients with pancreatic cancer. Pancreas 2006;33:45–52.

    Article  PubMed  Google Scholar 

  5. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244:10–15.

    Article  PubMed  Google Scholar 

  6. Rosso E, Bachellier P, Oussoultzoglou E, Scurtu R, Meyer N, Nakano H, Verasay G, Jaeck D. Toward zero pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. Am J Surg 2006;191:726–732.

    Article  PubMed  Google Scholar 

  7. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761–768.

    Article  PubMed  Google Scholar 

  8. Scurtu R, Bachellier P, Oussoultzoglou E, Rosso E, Maroni R, Jaeck D. Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg 2006;10:813–822.

    Article  PubMed  Google Scholar 

  9. Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C, Traverso LW, Pancreatic Anastomotic Leak Study Group. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg 2007;11:1451–1458.

    Article  PubMed  Google Scholar 

  10. Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg 2007;245:443–451.

    Article  PubMed  Google Scholar 

  11. Aranha GV, Aaron JM, Shoup M, Pickleman J. Current management of pancreatic fistula after pancreaticoduodenectomy. Surgery 2006;140:561–568.

    Article  PubMed  Google Scholar 

  12. Yang YM, Tian XD, Zhuang Y, Wang WM, Wan YL, Huang YT. Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol 2005;11(16):2456–2461.

    PubMed  Google Scholar 

  13. Oussoultzoglou E, Bachellier P, Bigourdan JM, Weber JC, Nakano H, Jaeck D. Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy. Arch Surg 2004;139:327–335.

    Article  PubMed  Google Scholar 

  14. Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg 2003;237:509–514.

    Article  PubMed  Google Scholar 

  15. Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg 2007;245:443–451.

    Article  PubMed  Google Scholar 

  16. House MG, Fong Y, Arnaoutakis DJ, Sharma R, Winston CB, Protic M, Gonen M, Olson SH, Kurtz RC, Brennan MF, Allen PJ. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 2008;12:270–278.

    Article  PubMed  Google Scholar 

  17. Okabayashi T, Kobayashi M, Nishimori I, Sugimoto T, Onishi S, Hanazaki K. Risk factors, predictors and prevention of pancreatic fistula formation after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg 2007;14:557–563.

    Article  PubMed  Google Scholar 

  18. Williams TK, Rosato EL, Kennedy EP, Chojnacki KA, Andrel J, Hyslop T, Doria C, Sauter PK, Bloom J, Yeo CJ, Berger AC. Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg 2009;208:210–217.

    Article  PubMed  Google Scholar 

  19. Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 2007;246:425–433.

    Article  PubMed  Google Scholar 

  20. Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ, Nakeeb A, Zyromski NJ, Lillemoe KD. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg 2007;246:1058–1064.

    Article  PubMed  Google Scholar 

  21. Delcore R, Rodriguez FJ, Forster J, Hermreck AS, Thomas JH. Significance of lymph node metastases in patients with pancreatic cancer undergoing curative resection. Am J Surg 1996;172:463–468.

    Article  PubMed  CAS  Google Scholar 

  22. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.

    Article  PubMed  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.

    Article  PubMed  Google Scholar 

  24. Bamgbade OA, Rutter TW, Nafiu OO, Dorje P. Postoperative complications in obese and nonobese patients. World J Surg 2007;31:556–560.

    Article  PubMed  Google Scholar 

  25. Sledzianowski JF, Duffas JP, Muscari F, Suc B, Fourtanier F. Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy. Surgery 2005;137:180–185.

    Article  PubMed  CAS  Google Scholar 

  26. Saisho Y, Butler AE, Meier JJ, Monchamp T, Allen-Auerbach M, Rizza RA, Butler PC. Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type-2 diabetes. Clin Anat 2007;20:933–942.

    Article  PubMed  CAS  Google Scholar 

  27. Olsen TS. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Pathol Microbiol Scan 1978;86A:367–373.

    CAS  Google Scholar 

  28. Fiorini RN, Kirtz J, Periyasamy B, Evans Z, Haines JK, Cheng G, Polito C, Rodwell D, Shafizadeh SF, Zhou X, Campbell C, Birsner J, Schmidt M, Lewin D, Chavin KD. Development of an unbiased method for the estimation of liver steatosis. Clin Transplant 2004;18:700–706.

    Article  PubMed  Google Scholar 

  29. Katz DS, Hines J, Math KR, Nardi PM, Mindelzun RE, Lane MJ. Using CT to reveal fat-containing abnormalities of the pancreas. AJR Am J Roentgenol 1999;172:393–396.

    PubMed  CAS  Google Scholar 

  30. Jaster R, Emmrich J. Crucial role of fibrogenesis in pancreatic diseases. Best Pract Res Clin Gastroentero. 2008;22:17–29.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur, Avenue Molière, 67200, Strasbourg, France

    Edoardo Rosso, Patrick Pessaux, Elie Oussoultzoglou, Fabrizio Panaro, Mahfud Mahfud, Daniel Jaeck & Philippe Bachellier

  2. Service d’Anatomie Pathologique, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur, Avenue Molière, 67098, Strasbourg, France

    Selenia Casnedi

Authors
  1. Edoardo Rosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Selenia Casnedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Pessaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elie Oussoultzoglou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabrizio Panaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mahfud Mahfud
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel Jaeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philippe Bachellier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philippe Bachellier.

Additional information

Grant support: None

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rosso, E., Casnedi, S., Pessaux, P. et al. The Role of “Fatty Pancreas” and of BMI in the Occurrence of Pancreatic Fistula After Pancreaticoduodenectomy. J Gastrointest Surg 13, 1845–1851 (2009). https://doi.org/10.1007/s11605-009-0974-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-009-0974-8

Keywords

Search

Navigation