title: Sarcopenia and survival in patients undergoing pancreatic resection.
abstract: BACKGROUND
  Recent studies have suggested that lean core muscle area may predict outcomes from major abdominal surgeries. Pancreatic resections have been independently analyzed less frequently.
  
  
  METHODS
  Pancreatic resections from 2005 to 2012 were reviewed. Sarcopenia was defined as the lowest tertile for lean psoas muscle area (LPMA). Preoperative risk factors, including comorbidities, albumin, weight loss, age and gender, were analyzed with a primary endpoint of overall survival. Secondary endpoints included complications, discharge destination and readmission.
  
  
  RESULTS
  The study sample of 270 patients had complications in 42% of patients, with 26% developing serious complication. The majority (80%) were discharged home, and 1.9% died in the peri-operative period. The mean length of follow up was 31.2 months (range 0-94), and 37% required at least one readmission. LPMA was predictive of discharge destination for females (p = 0.038). Sarcopenia was predictive of readmission in males, compared to subjects in the second LPMA tertile (HR 0.3; 95% CI: 0.1-0.9). In all male subjects, including a subset with adenocarcinoma, patients with sarcopenia were more likely to die than males in the highest LPMA tertile (HR: 2.6; 95% CI: 1.4-4.8 and HR: 2.4; 95% CI: 1.2-4.9, respectively). In all patients with pancreatic ductal adenocarcinoma, transfusion (HR: 1.9; 95% CI: 1.1-3.4) and positive margins (HR: 2.0; 95% CI: 1.2-3.3) were the only factors predictive of overall survival.
  
  
  CONCLUSIONS
  Sarcopenia appears to be a predictor of overall survival in male patients undergoing pancreatic resections, but not specifically for patients with pancreatic ductal adenocarcinoma. As prospective data in future studies are identified, sarcopenia may become a useful tool in predicting outcomes.
authors.affiliation: Department of Surgical Oncology, Mercy Health Physician Partners, Lack Cancer Center, USA. Electronic address: JillOnesti@gmail.com.
authors.forename: Jill K
authors.initials: JK
authors.lastname: Onesti
authors.affiliation: GRMEP/MSU General Surgery Residency, USA.
authors.forename: G Paul
authors.initials: GP
authors.lastname: Wright
authors.affiliation: GRMEP/MSU General Surgery Residency, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Kenning
authors.affiliation: GRMEP/MSU Diagnostic Radiology Residency, USA.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Tierney
authors.affiliation: GRMEP Research Department, USA; MSU Department of Surgery, USA.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: Advanced Radiology Services, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Doherty
authors.affiliation: MSU Department of Surgery, USA; Department of Surgical Oncology, Spectrum Health Medical Group, USA.
authors.forename: Mathew H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications*; D055815:Young Adult
keywords: Mortality; Outcomes; Pancreatectomy; Predictors; Sarcopenia; Survival