The impact of body mass index on pancreatic fistula after pancreaticoduodenectomy in Asian patients on the basis of Asia-Pacific perspective of body mass index.

Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
JOP: Journal of the pancreas 01/2011; 12(6):586-92.
Source: PubMed


Several surgical complications are related to obesity.
This study evaluated the impact of obesity on pancreatic fistula after pancreaticoduodenectomy.
We retrospectively reviewed the medical records of 159 patients who underwent pancreaticoduodenectomy between October 2002 and December 2008.
The patients were divided according to the body mass index as obese (body mass index equal to, or greater than, 25 kg/m(2)), or normal (body mass index less than 25 kg/m(2)).
Univariate and multivariate analyses were applied. Two-tailed P values less than 0.05 were considered as significant.
Forty-six patients (28.9%) were obese and 113 patients (71.1%) were normal-weight. Obese group had a significantly higher incidence of pancreatic fistula and a greater amount of intraoperative blood loss. Other surgical complications were not significantly different between the two groups. Multivariate analysis found obesity, small pancreatic duct size (less than, or equal to, 3 mm), intraoperative blood loss, and combined resection as significant factors affecting pancreatic fistula.
Obese patients have an increased risk for pancreatic fistula after pancreaticoduodenectomy.

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    ABSTRACT: Postoperative pancreatic fistula (POPF) remains a serious complication after pancreaticoduodenectomy (PD). Preoperative risk assessment of POPF is desirable in careful preparation for operation. The aim of this study was to assess simple and accurate risk factors for clinically relevant POPF based on a schematic understanding of the pancreatic configuration using preoperative multidetector computed tomography. Three hundred and eighteen consecutive patients who underwent PD in the National Cancer Center Hospital East between November 2006 and March 2013 were investigated. Pre-, intra-, and postoperative clinicopathological findings as well as pancreatic configuration data were analyzed for the risk of clinically relevant POPF. POPF was defined according to the International Study Group of Pancreatic Fistula classification. POPF grade A occurred in 52 patients (16.4 %), grade B in 84 (26.4 %), and grade C in 6 (1.9 %). Independent risk factors for POPF grade B/C included main pancreatic duct diameter (MPDd) < 2 mm (P = 0.001), parenchymal thickness ≥ 8 mm (P = 0.018), not performing portal vein/superior mesenteric vein resection (P = 0.004), and amylase level of drainage fluid on postoperative day 3 ≥ 375 IU/L (P < 0.001). Pancreatic configuration data including MPDd and parenchymal thickness were good indicators of clinically relevant POPF.
    No preview · Article · Aug 2013 · Journal of Gastrointestinal Surgery