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Impact of Obesity on Perioperative Outcomes and Survival Following Pancreaticoduodenectomy for Pancreatic Cancer: A Large Single-Institution Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

To examine the effect of body mass index (BMI) on clinicopathologic factors and long-term survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma.

Methods

Data on BMI, weight loss, operative details, surgical pathology, and long-term survival were collected on 795 patients who underwent pancreaticoduodenectomy. Patients were categorized as obese (BMI > 30 kg/m2), overweight (BMI 25 to <30 kg/m2), or normal weight (BMI < 25 kg/m2) and compared using univariate and multivariate analyses.

Results

At the time of surgery, 14% of patients were obese, 33% overweight, and 53% normal weight. Overall, 32% of patients had preoperative weight loss of >10%. There were no differences in operative times among the groups; however, higher BMI was associated with increased risk of blood loss (P < 0.001) and pancreatic fistula (P = 0.01). On pathologic analysis, BMI was not associated with tumor stage or number of lymph nodes harvested (both P > 0.05). Higher BMI patients had a lower incidence of a positive retroperitoneal/uncinate margin versus normal weight patients (P = 0.03). Perioperative morbidity and mortality were similar among the groups. Obese and overweight patients had better 5-year survival (22% and 22%, respectively) versus normal weight patients (15%; P = 0.02). After adjusting for other prognostic factors, as well as preoperative weight loss, higher BMI remained independently associated with improved cancer-specific survival (overweight: hazard ratio, 0.68; obese: hazard ratio, 0.72; both P < 0.05).

Conclusion

Obese patients had similar tumor-specific characteristics, as well as perioperative outcomes, compared with normal weight patients. However, obese patients undergoing pancreaticoduodenectomy for pancreatic cancer had an improved long-term survival independent of known clinicopathologic factors.

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References

  1. CDC. State-specific prevalence of obesity among adults: United States, 2005. Center of Disease Control and Prevention 2006.

  2. CDC. Overweight and obesity: health consequences. In Prevention. CfDCa, ed., Vol. 2007, 2007. eb Site. www.cdc.gov/obesity/causes/health.html.

  3. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006;355(8):763–778.

    Article  CAS  PubMed  Google Scholar 

  4. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348(17):1625–1638.

    Article  PubMed  Google Scholar 

  5. Larsson SC, Permert J, Hakansson N, et al. Overall obesity, abdominal adiposity, diabetes and cigarette smoking in relation to the risk of pancreatic cancer in two Swedish population-based cohorts. Br J Cancer 2005;93(11):1310–1315.

    Article  CAS  PubMed  Google Scholar 

  6. Hanley AJ, Johnson KC, Villeneuve PJ, Mao Y. Physical activity, anthropometric factors and risk of pancreatic cancer: results from the Canadian enhanced cancer surveillance system. Int J Cancer 2001;94(1):140–147.

    Article  CAS  PubMed  Google Scholar 

  7. Michaud DS, Giovannucci E, Willett WC, et al. Physical activity, obesity, height, and the risk of pancreatic cancer. Jama 2001;286(8):921–929.

    Article  CAS  PubMed  Google Scholar 

  8. Li D, Morris JS, Liu J, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. Jama 2009;301(24):2553–2562.

    Article  CAS  PubMed  Google Scholar 

  9. Klasen J, Junger A, Hartmann B, et al. Increased body mass index and peri-operative risk in patients undergoing non-cardiac surgery. Obes Surg 2004;14(2):275–281.

    Article  PubMed  Google Scholar 

  10. Dindo D, Muller MK, Weber M, Clavien PA. Obesity in general elective surgery. Lancet 2003;361(9374):2032–2035.

    Article  PubMed  Google Scholar 

  11. Mullen JT, Davenport DL, Hutter MM, et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol 2008;15(8):2164–2172.

    Article  PubMed  Google Scholar 

  12. Dhar DK, Kubota H, Tachibana M, et al. Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology 2000;59(1):18–23.

    Article  CAS  PubMed  Google Scholar 

  13. Gorog D, Nagy P, Peter A, Perner F. Influence of obesity on lymph node recovery from rectal resection specimens. Pathol Oncol Res 2003;9(3):180–183.

    Article  PubMed  Google Scholar 

  14. Gretschel S, Christoph F, Bembenek A, et al. Body mass index does not affect systematic D2 lymph node dissection and postoperative morbidity in gastric cancer patients. Ann Surg Oncol 2003;10(4):363–368.

    Article  PubMed  Google Scholar 

  15. Damadi AA, Julien L, Arrangoiz R, et al. Does obesity influence lymph node harvest among patients undergoing colectomy for colon cancer? Am Surg 2008;74(11):1073–1077.

    PubMed  Google Scholar 

  16. Fleming JB, Gonzalez RJ, Petzel MQ, et al. Influence of obesity on cancer-related outcomes after pancreatectomy to treat pancreatic adenocarcinoma. Arch Surg 2009;144(3):216–221.

    Article  PubMed  Google Scholar 

  17. Physical Status: The Use and Interpretation of Anthropometry: Report of a WHO Expert Committee, 1995.

  18. Greene FL, Page DL, Fleming ID (eds). AJCC Staging manual and handbook. 6th ed. Philadelphia: Lippincott Raven Publishers, 2002.

  19. Winter JM, Cameron JL, Campbell KA, et al. Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg 2006;10(9):1280–1290. discussion 90.

    Article  PubMed  Google Scholar 

  20. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. Jama 2006;295(13):1549–1555.

    Article  CAS  PubMed  Google Scholar 

  21. House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 2008;12(2):270–278.

    Article  PubMed  Google Scholar 

  22. Williams TK, Rosato EL, Kennedy EP, et al. Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg 2009;208(2):210–217.

    Article  PubMed  Google Scholar 

  23. Mathur A, Marine M, Lu D, et al. Nonalcoholic fatty pancreas disease. HPB (Oxford) 2007;9(4):312–318.

    Google Scholar 

  24. Mathur A, Zyromski NJ, Pitt HA, et al. Pancreatic steatosis promotes dissemination and lethality of pancreatic cancer. J Am Coll Surg 2009;208(5):989–994. discussion 94-6.

    Article  PubMed  Google Scholar 

  25. Noun R, Riachy E, Ghorra C, et al. The impact of obesity on surgical outcome after pancreaticoduodenectomy. Jop 2008;9(4):468–476.

    PubMed  Google Scholar 

  26. White RR, Xie HB, Gottfried MR, et al. Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer. Ann Surg Oncol 2005;12(3):214–221.

    Article  PubMed  Google Scholar 

  27. Gleisner AL, Choti MA, Assumpcao L, et al. Colorectal liver metastases: recurrence and survival following hepatic resection, radiofrequency ablation, and combined resection-radiofrequency ablation. Arch Surg 2008;143(12):1204–1212.

    Article  PubMed  Google Scholar 

  28. Kamat AM, Shock RP, Naya Y, et al. Prognostic value of body mass index in patients undergoing nephrectomy for localized renal tumors. Urology 2004;63(1):46–50.

    Article  PubMed  Google Scholar 

  29. Yu ML, Asal NR, Geyer JR. Later recurrence and longer survival among obese patients with renal cell carcinoma. Cancer 1991;68(7):1648–1655.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Medical Institutions, Harvey 611, 600N Wolfe Street, Baltimore, MD, 21287, USA

    Susan Tsai, Michael A. Choti, Lia Assumpcao, John L. Cameron, Ana L. Gleisner, Frederic Eckhauser, Barish H. Edil, Richard D. Schulick, Christopher L. Wolfgang & Timothy M. Pawlik

  2. Department of Radiation Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Joseph M. Herman

Authors
  1. Susan Tsai
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  2. Michael A. Choti
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  3. Lia Assumpcao
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  4. John L. Cameron
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  5. Ana L. Gleisner
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  6. Joseph M. Herman
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  7. Frederic Eckhauser
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  8. Barish H. Edil
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  9. Richard D. Schulick
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  10. Christopher L. Wolfgang
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  11. Timothy M. Pawlik
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Correspondence to Timothy M. Pawlik.

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Tsai, S., Choti, M.A., Assumpcao, L. et al. Impact of Obesity on Perioperative Outcomes and Survival Following Pancreaticoduodenectomy for Pancreatic Cancer: A Large Single-Institution Study. J Gastrointest Surg 14, 1143–1150 (2010). https://doi.org/10.1007/s11605-010-1201-3

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  • DOI: https://doi.org/10.1007/s11605-010-1201-3

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