Body Composition Influences Post-Operative Complications and 90-Day and Overall Survival in Pancreatic Surgery Patients

Abstract

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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, <i>p</i> = 0.03) and 90-day survival (HR 2.13, 95% CI 1.13–4.01, <i>p</i> = 0.019). On simple analysis, shorter overall survival (OS) was observed in patients aged ≥70 years (<i>p</i> = 0.0009), with postoperative complications ≥IIIb (<i>p</i> = 0.01), an increased VFA:SMA (<i>p</i> = 0.007), and decreased muscle radiation attenuation (<i>p</i> = 1.6 × 10<sup>–5</sup>). 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, <i>p</i> = 0.0016). A model which included only body composition variables had a discrimination ability (<i>C</i>-statistic 0.76) superior to a model which comprised conventional clinical variables (<i>C</i>-statistic 0.68). <b><i>Conclusion:</i></b> Body composition is a major determinant of postoperative complications and survival in pancreatic surgery patients.