Impact of obesity on surgical outcomes post-pancreaticoduodenectomy: a case-control study.
BACKGROUND
Obesity is a growing worldwide epidemic. There is association between obesity and pancreatic cancer risk. However, the impact of obesity on the outcome of pancreatoduodenectomy (PD) is controversial. The aim of this study was to elucidate effect of obesity on surgical outcomes of PD.


METHODS
A case-control study.


METHODS
We retrospectively studied all patients who underwent PD in our center between January 2000 and June 2012. Patients were divided into two groups; Group A (patients with BMI <25) and Group B (patients with BMI > 25). Preoperative demographic data, intraoperative data, and postoperative details were collected.


RESULTS
Only 112/471 patients (25.9%) had BMI > 25. The median intraoperative blood loss was more in overweight patients (P = 0.06). The median surgical time in group B was significantly longer than that in group A (P = 0.003). The overall incidence of complications was higher in the overweight group (P = 0.001). The severity of complications was also higher in the overweight group (P = 0.0001). Postoperative pancreatic fistula (POPF) (P = 0.0001) and hospital mortality (P = 0.001) were significantly higher in overweight patients. Oral intake was significantly delayed in overweight patients in comparison to normal weight group (P = 0.02). Postoperative stay was significantly longer in overweight patients (P = 0.0001).


CONCLUSIONS
PD is associated with an increased risk of postoperative morbidity in overweight patient. Overweight patients must not be precluded from undergoing PD. However, operative techniques and pharmacological prophylaxis to decrease POPF should be considered in overweight patients.
Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt. Electronic address: elnakeebayman@gmail.com.
Ayman
A
El Nakeeb
Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
Hosam
H
Hamed
Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
Ahmed
A
Shehta
Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
Waleed
W
Askr
Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
Mohamed
M
El Dosoky
Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
Rami
R
Said
Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
Talaat
T
Abdallah
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology*; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Obesity; Pancreatic fistula; Pancreaticodudenectomy