P-164 Postoperative skeletal muscle loss negatively impacts survival after pancreaticoduodenectomy in periampullary cancers

Abstract

There have been a few studies showing that sarcopenia is associated with decreased survival in patients with periampullary cancer; however, postoperative muscle changes and their effects on survival in cancer patients undergoing pancreaticoduodenectomy have not been well studied. This study aimed to assess the degree of postoperative muscle changes and their effect on survival of patients with surgically treated periampullary cancer. We analyzed data of patients diagnosed with ampulla of Vater, distal common bile duct, and pancreatic head cancer who underwent pancreaticoduodenectomy from 2008 to 2015. Skeletal muscle areas and changes at L3 vertebral levels obtained before and after cancer resection. The percent change in skeletal muscle between the first and follow-up scans were calculated as the percent change per 60 days. Among 242 patients, 80 (33.1%) had decreased muscle mass (10%/60 days) after surgery. The remaining 150 (62.0%) did not show a significant postoperative muscle change. Mean postoperative muscle change was -6.4 ± 13.8 %/60days and there was no difference among the type of cancer. There was a significant difference in overall survival according to the postoperative muscle change (p=0.023). Median survival for muscle-losers, patients without significant change, and muscle-gainers were 22.7, 32.6, and 67.8 months, respectively. Postoperative muscle loss (hazard ratio [HR], 1.93: 95% confidence interval [CI], 1.33-2.80) and gain (HR, 0.37: 95% CI, 0.15-0.95) were identified as independent predictors of survival on multivariable analyses. Postoperative muscle change can be one of the predictive factors for overall survival in patients with periampullary cancer after pancreatoduodenectomy. Active nutrition and rehabilitation management may be recommended to reduce excessive muscle loss after pancreaticoduodenectomy.