A high visceral adipose tissue-to-skeletal muscle ratio as a determinant of major complications after pancreatoduodenectomy for cancer.
OBJECTIVE
Complication rates after pancreatic resections remain high despite improvement in perioperative management. The effects of body composition and the relationship among different body compartments on surgical morbidity are not comprehensively investigated. The aim of this study was to assess whether the evaluation of different body compartments and their relationship was associated with the development of major postoperative complications after pancreatoduodenectomy (PD) for cancer.


METHODS
We retrospectively analyzed 124 patients who underwent PD and had a staging computed tomography (CT) scan at our center. CT scan was used to measure abdominal skeletal muscle area and volume, as well as visceral fat area (VFA) and volume. The total abdominal muscle area (TAMA) was then normalized for height. The severity of complications was assessed. Univariate and multivariate analyses were performed to investigate correlations between the above variables and postoperative complications. The receiver operating characteristic curve methodology was used to investigate the predictive ability of each parameter.


RESULTS
Major complications occurred in 42 patients (33.9%). The prevalence of sarcopenia was 24.2%. Regression analyses revealed no correlation between abdominal muscular and adipose tissue areas. Univariate analysis showed that the depletion of muscle area normalized for height was not per se predictive of complications (P = 0.318). Multivariate logistic regression showed that the VFA/TAMA was the only determinant of major complications (odds ratio, 3.20; 95% confidence interval, 1.35-7.60; P = 0.008). The model predictive performance was 0.735 (area under the curve) with a sensitivity of 64.3% and a specificity of 74.4%.


CONCLUSIONS
Sarcopenic obesity is a strong predictor of major complications after PD for cancer.
School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
Marta
M
Sandini
School of Medicine and Surgery, Center of Biostatistics for Clinical Epidemiology, Milano-Bicocca University, Monza, Italy.
Davide P
DP
Bernasconi
Department of Radiology, San Gerardo Hospital, Monza, Italy.
Davide
D
Fior
School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
Matilde
M
Molinelli
Department of Radiology, San Gerardo Hospital, Monza, Italy.
Davide
D
Ippolito
School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
Luca
L
Nespoli
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Riccardo
R
Caccialanza
School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy. Electronic address: luca.gianotti@unimib.it.
Luca
L
Gianotti
D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology
Body composition; Morbidity; Obesity; Pancreas; Sarcopenia; Surgery