title: Influence of visceral obesity for postoperative pulmonary complications after pancreaticoduodenectomy.
abstract: BACKGROUND
  We conduct this study to determine whether postoperative complications, including postoperative pulmonary complications (PPCs), are associated with BMI and visceral fat area (VFA) after pancreaticoduodenectomy.
  
  
  METHODS
  A total of 317 patients undergoing pancreaticoduodenectomy were enrolled. VFA was measured using a cross-sectional computed tomography (CT) scan at the level of the umbilicus by FatScan software version 3.0 (N2 systems Inc., Osaka, Japan). Clinicopathological variables, intraoperative outcomes, and postoperative courses were analyzed.
  
  
  RESULTS
  Of all patients, 130 (41.0%) had postoperative complications and PPCs occurred in 14 patients (4.4%). VFA were significantly higher in patients who developed postoperative pancreatic fistula (POPF), PPCs, and mortality than in those patients who did not (P = .0282, P = .0058, and P = .0173, respectively). Multivariate analysis demonstrated that high BMI and high VFA were not independent predictive risk factors for POPF grade B/C and mortality; only high VFA was an independent risk factor influencing PPCs (P = .0390, odds ratio 4.246, 95% confidence interval 1.076-16.759).
  
  
  CONCLUSIONS
  Visceral obesity was the independent risk factor for the incidence of PPCs after pancreaticoduodenectomy. Preoperative VFA measurement using CT scan is a useful tool for the prediction of the development of PPCs compared to BMI calculation.
authors.affiliation: Second Department of Surgery, School of Medicine, Wakayama Medical University,Wakayama, 641-8510, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.forename: Motoki
authors.initials: M
authors.lastname: Miyazawa
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications / Q000473:pathology*; D016577:Pancreaticoduodenectomy; D011014:Pneumonia / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D001261:Pulmonary Atelectasis / Q000209:etiology*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed