Visceral adipose tissue and skeletal muscle index distribution predicts development of severe pancreatic fistula after pancreaticoduodenectomy

Abstract

Background: Pancreatic fistula (PF) development after pancreaticoduodenectomy (PD) remains a life-threatening complication. In this study, we investigated the impact of body composition on PF development after PD. Methods: Ninety-nine patients with pancreatic and extrahepatic biliary malignancy following PD who were treated in our department between 2006 and 2016 were enrolled. Univariate and multivariate analyses were performed to investigate variables associated with PF. The 2005 international pancreatic fistula criteria were used to define PF. Results: The median age of subjects was 72 years and 69 patients were male. The overall mortality and morbidity rates were 1.0% and 36.4%, respectively. The severe PF (grade B, C) was developed in 30 patients, of which 25 patients (25.3%) were classified as grade B in and 5patients (5%) were classified as grade C. Univariate analysis identified that body mass index ≥25 kg/m2 (p=0.032), vesicle adipose tissue area (VATA)/skeletal muscle index (SMI) ≥2.0 (p=0.002), main pancreatic duct diameter ≤3 mm (p<0.001) and drain amylase (Amy) at postoperative day (POD) 1 ≥5000 U/L (p<0.001) were significantly associated with severe PF after PD. Multivariate analysis indicated that VATA/SMI ≥2.0 (p=0.009), pancreatic duct diameter ≤3 mm (p=0.003) and drain Amy at POD1 ≥5000 U/L (p=0.032) were independent risk factors for PF. Conclusion: Preoperative assessment of VATA/SMI has an important role in predicting PF development after PD.