title: Body mass index and outcomes from pancreatic resection: a review and meta-analysis.
abstract: BACKGROUND
  There are 1.6 billion adults worldwide who are overweight, with body mass indices (BMI) between 25 and 30, while more than 400 million are obese (BMI >30). Obesity predicts the incidence of and poor outcomes from pancreatic cancer. Obesity has also been linked to surgical complications in pancreatectomy, including increased length of hospital stay, surgical infections, blood loss, and decreased survival. However, BMI's impact on many complications following pancreatectomy remains controversial.
  
  
  METHODS
  We performed a MEDLINE search of all combinations of "BMI" with "pancreatectomy," "pancreatoduodenectomy," or "pancreaticoduodenectomy." From included studies, we created pooled and weighted estimates for quantitative and qualitative outcomes. We used the PRISMA criteria to ensure this project's validity.
  
  
  RESULTS
  Our primary cohort included 2,736 patients with BMI <30, 1,682 with BMI >25, and 546 with BMI between 25 and 30. Most outcomes showed no definitive differences across BMIs. Pancreatic fistula (PF) rates ranged from 4.7% to 31.0%, and four studies found multivariate association between BMI and PF (range odds ratio 1.6-4.2). Pooled analyses of PF by BMI showed significant association (p < 0.05).
  
  
  CONCLUSIONS
  BMI increases the operative complexity of pancreatectomy. However, with aggressive peri- and post-operative care, increases in BMI-associated morbidity and mortality may be mitigated.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville School Medicine, Louisville, KY 40202, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Ramsey
authors.forename: Robert C
authors.initials: RC
authors.lastname: Martin
mesh_terms: D015992:Body Mass Index; D006801:Humans; D009765:Obesity / Q000150:complications*; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology*