Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea.
Department of Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea.
Eur Radiol. 2019 May;29(5):2417-2425. doi: 10.1007/s00330-018-5790-7. Epub 2018 Nov 7.
To evaluate predictive values of sarcopenia and visceral obesity measured from preoperative CT/MRIs for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy in patients with periampullary malignancies.
From the prospectively constructed surgical registry, we included adult patients treated with pancreaticoduodenectomy. Based on CT/MRIs, body morphometric analysis was performed to evaluate the visceral obesity and sarcopenia, based on the areas of visceral fat and skeletal muscle measured at the L3 vertebrae level. We retrieved various perioperative factors from registry. As outcomes of postoperative complications, we evaluated POPF and major complications based on the Clavien-Dindo classification. Multivariate logistic regression analyses were performed.
From a total of 284 patients (163 males, 121 females) who met the inclusion/exclusion criteria, POPF, major complications, and 60-day mortality occurred in 52 (18.3%), 34 (12.0%), and 6 (2.1%), respectively. Sarcopenia and visceral obesity were noted in 123 (75.5%) and 66 (40.5%) of men and 68 (56.2%) and 53 (43.8%) of women, respectively. Combination of sarcopenia and obesity (sarcopenic obesity) was noted in 31.9% (52/163) of men and in 26.4% (32/121) of women. In multivariate logistic regression analyses, sarcopenic obesity was the only independent predictor for POPF (OR 2.65, 95% CI 1.43-4.93), and the vascular resection during pancreaticoduodenectomy was the only independent predictor for severe complications (OR 3.75, 95% CI 1.61-8.70).
Sarcopenic obesity might be highly predictive for POPF. Body morphometric analysis in preoperative CT/MRI combined with assessment of perioperative clinical features may help to identify high-risk patients and determine perioperative management strategies.
• Sarcopenic obesity might be predictive for postoperative pancreatic fistula after pancreaticoduodenectomy. • The vascular resection during pancreaticoduodenectomy might be predictive of major complications. • Body morphometric analysis might be helpful for identifying high-risk patients.
评估术前 CT/MRI 测量的骨骼肌减少症和内脏肥胖对胰十二指肠切除术（PD）后壶腹周围恶性肿瘤患者术后胰瘘（POPF）的预测价值。
从前瞻性构建的外科登记处中，我们纳入了接受 PD 治疗的成年患者。根据 CT/MRI，通过测量 L3 椎体水平的内脏脂肪和骨骼肌面积来进行体形态计量分析，以评估内脏肥胖和骨骼肌减少症。我们从登记处中检索了各种围手术期因素。作为术后并发症的结果，我们根据 Clavien-Dindo 分类评估了 POPF 和主要并发症。进行了多变量逻辑回归分析。
在总共 284 名符合纳入/排除标准的患者（163 名男性，121 名女性）中，发生了 52 例（18.3%）、34 例（12.0%）和 6 例（2.1%）的 POPF、主要并发症和 60 天死亡率。在男性中，分别有 123 例（75.5%）和 66 例（40.5%）出现骨骼肌减少症和内脏肥胖，而女性中分别有 68 例（56.2%）和 53 例（43.8%）出现骨骼肌减少症和内脏肥胖。在男性中，31.9%（52/163）存在骨骼肌减少症合并肥胖（肌少性肥胖），在女性中，26.4%（32/121）存在肌少性肥胖。在多变量逻辑回归分析中，肌少性肥胖是 POPF 的唯一独立预测因素（OR 2.65，95%CI 1.43-4.93），PD 期间的血管切除是严重并发症的唯一独立预测因素（OR 3.75，95%CI 1.61-8.70）。
肌少性肥胖可能高度预测 POPF。术前 CT/MRI 的体形态计量分析结合围手术期临床特征的评估可能有助于识别高危患者并确定围手术期管理策略。
• 肌少性肥胖可能是 PD 后胰瘘的预测因素。
• PD 期间的血管切除可能是严重并发症的预测因素。
• 体形态计量分析可能有助于识别高危患者。
