Rising BMI is Associated with Increased Rate of Clinically Relevant Pancreatic Fistula after Distal Pancreatectomy for Pancreatic Adenocarcinoma

Abstract

Clinically relevant pancreatic fistula (CR-POPF), after distal pancreatectomy (DP), remains a clinical challenge. Prior studies investigating the relationship between BMI and CR-POPF have yielded conflicting results. We hypothesized that BMI is associated with CR-POPF in patients having DP for pancreatic ductal adenocarcinoma (PDAC). Patients who underwent DP for PDAC at a single institution from 2006 to 2018 were retrospectively reviewed. A CR-POPF was defined as International Study Group of Pancreatic Surgery (ISGPS) grade B or C fistula. Uni- and multivariable logistic regression analysis assessed factors associated with CR-POPF after DP. Seventy-eight patients met the inclusion criteria, 51 per cent were female, 51 per cent were white, and the average age was 59 ± 15 years. The median BMI was 26 (IQR 24–29). Of all, 19 per cent (n = 15) of patients had a CR-POPF. With a mean follow-up of 2.8 ± 2.5 years, the presence of a CR-POPF was not associated with survival ( P = 0.17). On univariable logistic regression, older age was associated with a decreased risk of CR-POPF (odds ratio (OR) = 0.95, P = 0.015). Increasing BMI was associated with an increased risk of CR-POPF (OR = 1.1, P = 0.044). On multivariate analysis, after controlling for multiple factors, BMI (OR = 1.12, P = 0.035) was the only factor associated with the development of a CR-POPF, whereas older age (OR = 0.94, P < 0.001) was slightly protective. Increasing BMI is associated with an increased risk of CR-POPF after DP for PDAC. These findings should be considered during preoperative counseling. Efforts to diminish the risk of CR-POPF should be focused on patients with higher BMI.

Risk Factor Analysis of Postoperative Pancreatic Fistula After Distal Pancreatectomy, with A Focus on Pancreas-Visceral Fat CT Value Ratio and Serrated Pancreatic Contour, Evaluated Using Preoperative CT Images: A Retrospective Single Center Study

“…The previously reported representative risk factors for POPF after DP include obesity, younger age, malnutrition, and soft pancreas [2][3][4][5], but many reports have indicated that pancreatic thickness is the most important risk factor [17]. Univariate analysis in the present study showed that, among the abovementioned factors, high BMI (obesity), younger age, and pancreatic thickness were detected as risk factors, and multivariate analysis showed that high BMI (obesity) and pancreatic thickness were detected as independent risk factors; these results are similar to those in previous reports.…”

“…There is a higher incidence of postoperative pancreatic stula (POPF) after distal pancreatectomy (DP) than thatafter pancreaticoduodenectomy (PD) [1];POPFisthe most clinically problematic complication of these procedures. Various risk factors for POPF after DP have been reportedthus far, including obesity, younger age, malnutrition, pancreatic thickness,and soft pancreatic texture (i.e.,soft pancreas) [2][3][4][5]. Althoughmost of these factors can beevaluated preoperatively, pancreatictexturecan be determined only by intraoperative ndings.…”

Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy, with a focus on pancreas-visceral fat CT value ratio and serrated pancreatic contour

“…The previously reported representative risk factors for POPF after DP include obesity, younger age, malnutrition, and soft pancreas [ 10 – 13 ], but many reports have indicated that pancreatic thickness is the most important risk factor [ 26 ]. As the global population ages, the demand for pancreatic surgery in elderly patients has increased [ 27 , 28 ].…”

“…Thus, there is a higher incidence of POPF after DP than that after PD [ 9 ]. Various risk factors for POPF after DP have been reported thus far, including obesity, younger age, malnutrition, pancreatic thickness, and soft pancreatic texture (i.e., soft pancreas) [ 10 – 13 ]. Although most of these factors can be evaluated preoperatively, pancreatic texture can be determined only by intraoperative findings.…”

Preferential Mobilization of Colonic Hepatic Flexure Facilitates Pancreaticoduodenectomy Procedures

“…Overweight and obesity is perceived to be a risk factor for intraoperative and postoperative incidents 15. Elevated POPF rates have been observed in obese patients, compared with patients who have normal BMI, after pancreatic surgery 16. Increased fatty infiltration is considered to be responsible for increased risk of POPF, to some extent 17.…”