title: Impact of body mass index for patients undergoing pancreaticoduodenectomy.
abstract: OBJECTIVE
  To evaluate the impact of body mass index (BMI) on short and long term results after pancreaticoduodenectomies (PD).
  
  
  METHODS
  A consecutive series of PDs performed at the Karolinska University Hospital from 2004 till 2010 were retrieved from our prospective database. The patients were divided by BMI into overweight/obese (O; BMI ≥ 25 kg/m(2)) and controls (C; BMI < 25 kg/m(2)). Demographics, peri-operative data, morbidity, mortality, pancreatic fistula (PF) rate, length of stay (LOS), hospital costs, histology, and survival were analyzed. An additional sub analysis of survival was performed in patients with a diagnosis of pancreatic ductal adenocarcinoma (PDAC) and divided in underweight, normal-weight, overweight and obese.
  
  
  RESULTS
  A total of 367 PDs were included (O = 141/C = 226). No differences were found between O and C regarding demographics, peri-operative data, costs, morbidity or mortality. O was associated with higher intra-operative blood loss (1392 ± 115 mL vs 1121 ± 83 mL; P = 0.01), rate of PF (20% vs 9.5%; P = 0.006) and marginally longer LOS (18 ± 0.9 d vs 15 ± 1.1 d; P = 0.05). An increasing risk for PF was observed with increasing BMI. The 1, 3 and 5 years survival rate was similar in O and C in PDAC (68.7%, 26.4% and 8.8% vs 66.1%, 30.9% and 17.9% respectively; P = 0.9). When the survival was analyzed using 4 different categories of BMI (underweight, normal, overweight and obese), a trend was seen toward a difference in survival, with a worse prognosis for the underweight and obese patients compared to normal weight and overweight patients.
  
  
  CONCLUSIONS
  Overweight increases the risk for intra-operative bleeding and PF, but do not otherwise alter short or long term outcome after PD for pancreatic cancer.
authors.affiliation: Marco Del Chiaro, Elena Rangelova, Christoph Ansorge, John Blomberg, Ralf Segersvärd, Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute at Karolinska University Hospital, 14186 Stockholm, Sweden.
authors.forename: Marco
authors.initials: M
authors.lastname: Del Chiaro
authors.forename: Elena
authors.initials: E
authors.lastname: Rangelova
authors.forename: Christoph
authors.initials: C
authors.lastname: Ansorge
authors.forename: John
authors.initials: J
authors.lastname: Blomberg
authors.forename: Ralf
authors.initials: R
authors.lastname: Segersvärd
keywords: Body mass index; Oncology; Pancreas cancer; Pancreas surgery; Pancreatectomy; Pancreatico- duodenectomy