Sarcopenic obesity in hepatopancreaticobiliary malignancy

Abstract

Objectives: Sarcopenia is the progressive loss of skeletal muscle mass and strength. This single-center, retrospective cohort study compares outcomes of patients with sarcopenia and/or obesity who underwent pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDA). Methods: We analyzed clinical outcomes of 52 patients who underwent a PD for PDA from 2008 to 2013 across four cohorts: sarcopenic; obese; sarcopenic and obese; and neither sarcopenic nor obese. Sarcopenia was quantified using CT imaging to measure total cross sectional skeletal muscle area at the 3rd lumbar area normalized for height. Obesity was defined as body mass index greater than 30. Results: Of 52 patients, 52% were male, 65% had diabetes and 40% were sarcopenic. Among cohorts, 35% were non-sarcopenic/non-obese, 33% were sarcopenic/non-obese, 7% were sarcopenic/obese, and 25% were non-sarcopenic/obese. A statistically significant difference in pancreatic leak and pancreatic fistula formation was observed (p<0.01 and p<0.05, respectively). Pancreatic leak was observed in 33% of the sarcopenic/obese cohort and 0% in the other sub-groups. Pancreatic fistula was observed in 24% of sacropenic patients and in only 3% of non-sarcopenic patients, with 50% in sarcopenic/obese and 18% in sarcopenic/non-obese. Delayed gastric emptying occurred in 38% of sarcopenic patients compared to 16% in non-sarcopenic patients. There was no statistically significant difference in mortality and overall survival. Conclusion: Patients with PDA and sarcopenia who undergo PD are at higher risk of post-operative complications including pancreatic leak, pancreatic fistula formation and delayed gastric emptying. Peri-operative nutritional optimization to treat sarcopenia may improve outcomes following PD. Disclosure of Interest: None declared.