Velho Sónia, Costa Santos Maria Pia, Cunha Cátia, Agostinho Lisa, Cruz Rita, Costa Filipe, Garcia Mafalda, Oliveira Paulo, Maio Rui, Baracos Vickie E, Cravo Marília
Dietetics and Nutrition, Hospital Beatriz Ângelo, Loures, Portugal.
Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal.
GE Port J Gastroenterol. 2020 Dec;28(1):13-25. doi: 10.1159/000507206. Epub 2020 May 19.
Pancreatic surgery still carries a high morbidity and mortality even in specialized centers. The aim of this study was to evaluate the influence of patients' body composition on postoperative complications and survival after pancreatic surgery.
This was a retrospective study on patients undergoing pancreatic surgery between March 2012 and December 2017. Demographics, clinical data, and postoperative complications classified according to Clavien-Dindo were recorded. Body composition was assessed using routine diagnostic or staging computed tomography (CT). Multiple Cox proportional hazards models were adjusted.
Ninety patients were included, 55% were male, and the mean age was 68 ± 10.9 years. Of these 90, 92% had a total pancreatectomy or pancreaticoduodenectomy, 7% a distal pancreatectomy, and 1% a pancreaticoduodenectomy with multi-visceral resection; 84% had malignant disease. The incidence of major complications was 27.8% and the 90-day mortality was 8.8%. The ratio of visceral fat area/skeletal muscle area (VFA:SMA) was associated with an increased risk of complications (OR 2.24, 95% CI 1.14-4.87, = 0.03) and 90-day survival (HR 2.13, 95% CI 1.13-4.01, = 0.019). On simple analysis, shorter overall survival (OS) was observed in patients aged ≥70 years ( = 0.0009), with postoperative complications ≥IIIb ( = 0.01), an increased VFA:SMA ( = 0.007), and decreased muscle radiation attenuation ( = 1.6 × 10). In an OS model adjusted for age, disease malignancy, postoperative complications, and body composition parameters, muscle radiation attenuation remained significantly associated with survival (HR 0.94, 95% CI 0.90-0.98, = 0.0016). A model which included only body composition variables had a discrimination ability (-statistic 0.76) superior to a model which comprised conventional clinical variables (-statistic 0.68).
Body composition is a major determinant of postoperative complications and survival in pancreatic surgery patients.
即使在专业中心，胰腺手术的发病率和死亡率仍然很高。本研究的目的是评估患者身体组成对胰腺手术后并发症和生存的影响。
这是一项对2012年3月至2017年12月期间接受胰腺手术患者的回顾性研究。记录了人口统计学、临床数据以及根据Clavien-Dindo分类的术后并发症。使用常规诊断或分期计算机断层扫描（CT）评估身体组成。调整了多个Cox比例风险模型。
纳入90例患者，55%为男性，平均年龄为68±10.9岁。在这90例患者中，92%进行了全胰切除术或胰十二指肠切除术，7%进行了胰体尾切除术，1%进行了多脏器切除的胰十二指肠切除术；84%患有恶性疾病。主要并发症的发生率为27.8%，90天死亡率为8.8%。内脏脂肪面积/骨骼肌面积（VFA:SMA）比值与并发症风险增加（OR 2.24，95%CI 1.14 - 4.87，P = 0.03）和90天生存率（HR 2.13，95%CI 1.13 - 4.01，P = 0.019）相关。简单分析显示，年龄≥70岁的患者总体生存期（OS）较短（P = 0.0009），术后并发症≥IIIb级的患者（P = 0.01），VFA:SMA增加（P = 0.007）以及肌肉辐射衰减降低（P = 1.6×10）。在根据年龄、疾病恶性程度、术后并发症和身体组成参数调整的OS模型中，肌肉辐射衰减仍与生存显著相关（HR 0.94，95%CI 0.90 - 0.98，P = 0.0016）。仅包含身体组成变量的模型的判别能力（C统计量0.76）优于包含传统临床变量的模型（C统计量0.68）。
身体组成是胰腺手术患者术后并发症和生存的主要决定因素。
