title: Preoperative computed tomography measurements of pancreatic steatosis and visceral fat: prognostic markers for dissemination and lethality of pancreatic adenocarcinoma.
abstract: BACKGROUND
  Increased visceral fat and pancreatic steatosis promote lymphatic metastases and decreased survival in patients with pancreatic adenocarcinoma after pancreatoduodenectomy (PD).
  
  
  OBJECTIVE
  We aim to determine the utility of preoperative computed tomography (CT) measurements of pancreatic steatosis and visceral fat as prognostic indicators in patients with pancreatic adenocarcinoma.
  
  
  METHODS
  High-resolution CT scans of 42 patients undergoing PD for pancreatic adenocarcinoma were reviewed. Attenuation in CT of the pancreas, liver and spleen were measured in Hounsfield units and scored by two blinded investigators. Perirenal adipose tissue was measured in mm.
  
  
  RESULTS
  Lymphatic metastases were present in 57% of patients. Age, gender, tumour size and margin status were similar in patients with and without nodal metastases. Node-positive patients had increased visceral but not subcutaneous fat pads compared with node-negative patients and decreased CT attenuation of the pancreatic body and tail and liver. Node-positive patients stratified by visceral adiposity (≥10 mm vs. <10 mm) demonstrated poorer survival (7 ± 1 months vs. 16 ± 2 months; P < 0.01).
  
  
  CONCLUSIONS
  In resected pancreatic adenocarcinoma, increased pancreatic steatosis and increased visceral fat stores are associated with lymphatic metastases. Furthermore, increased visceral fat is associated with abbreviated survival in patients with lymphatic metastases. Hence, increased visceral fat may be a causative factor of abbreviated survival and serves a prognostic role in patients with pancreatic malignancies.
authors: Tampa General Hospital, Tamps, FL, USA.
authors: Abhishek
authors: A
authors: Mathur
authors: Jonathan
authors: J
authors: Hernandez
authors: Fawad
authors: F
authors: Shaheen
authors: Miloni
authors: M
authors: Shroff
authors: Sujat
authors: S
authors: Dahal
authors: Connor
authors: C
authors: Morton
authors: Thomas
authors: T
authors: Farrior
authors: Raj
authors: R
authors: Kedar
authors: Alexander
authors: A
authors: Rosemurgy
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