Division of Surgical Oncology, Department of Surgery, University of Louisville School Medicine, Louisville, KY 40202, USA.
J Gastrointest Surg. 2011 Sep;15(9):1633-42. doi: 10.1007/s11605-011-1502-1. Epub 2011 Apr 12.
There are 1.6 billion adults worldwide who are overweight, with body mass indices (BMI) between 25 and 30, while more than 400 million are obese (BMI >30). Obesity predicts the incidence of and poor outcomes from pancreatic cancer. Obesity has also been linked to surgical complications in pancreatectomy, including increased length of hospital stay, surgical infections, blood loss, and decreased survival. However, BMI's impact on many complications following pancreatectomy remains controversial.
We performed a MEDLINE search of all combinations of "BMI" with "pancreatectomy," "pancreatoduodenectomy," or "pancreaticoduodenectomy." From included studies, we created pooled and weighted estimates for quantitative and qualitative outcomes. We used the PRISMA criteria to ensure this project's validity.
Our primary cohort included 2,736 patients with BMI <30, 1,682 with BMI >25, and 546 with BMI between 25 and 30. Most outcomes showed no definitive differences across BMIs. Pancreatic fistula (PF) rates ranged from 4.7% to 31.0%, and four studies found multivariate association between BMI and PF (range odds ratio 1.6-4.2). Pooled analyses of PF by BMI showed significant association (p < 0.05).
BMI increases the operative complexity of pancreatectomy. However, with aggressive peri- and post-operative care, increases in BMI-associated morbidity and mortality may be mitigated.
全球有 16 亿成年人超重，体重指数（BMI）在 25 至 30 之间，而超过 4 亿人肥胖（BMI>30）。肥胖可预测胰腺癌的发病率和不良预后。肥胖还与胰切除术的手术并发症有关，包括住院时间延长、手术感染、失血和生存率降低。然而，BMI 对胰切除术后许多并发症的影响仍存在争议。
我们对所有与“BMI”与“胰切除术”、“胰十二指肠切除术”或“胰十二指肠切除术”相结合的 MEDLINE 进行了搜索。从纳入的研究中，我们为定量和定性结果创建了汇总和加权估计值。我们使用 PRISMA 标准来确保该项目的有效性。
我们的主要队列包括 2736 名 BMI<30 的患者、1682 名 BMI>25 的患者和 546 名 BMI 在 25 至 30 之间的患者。大多数结果在 BMI 之间没有明显差异。胰瘘（PF）发生率为 4.7%至 31.0%，四项研究发现 BMI 与 PF 之间存在多变量关联（比值比范围为 1.6-4.2）。按 BMI 对 PF 进行的汇总分析显示存在显著相关性（p<0.05）。
BMI 增加了胰切除术的手术复杂性。然而，通过积极的围手术期和术后护理，BMI 相关发病率和死亡率的增加可能会得到缓解。
