Impact of obesity on short and long term results following a pancreatico-duodenectomy

Abstract

Background: The impact of obesity on short and long term outcomes following a pancreatico-duodenectomy (PD) is still unclear and needs further clarification.

Methods: Demographic, operative and outcomes data in 524 patients undergoing PD were analysed.

Results: Ninety-seven patients (18.5%) had BMI greater than or equal to 30 kg/m² (group A) and 427 patients (81.5%) had BMI less than 30 kg/m² (group B). Group A had a significantly greater operative duration, (375 vs 360 min, p = 0.024) and a higher intra-operative blood loss, (660 vs 500 ml, p = 0.005). Post-operative pancreatic fistula (POPF) were more common in Group A (28.9% vs 16.2%, p = 0.006), this difference was also observed when considering only major POPF (Grade B and C) (16.5% vs 8.0%, p = 0.020). Intra-abdominal collections were higher in Group A, 28.9% compared to 19.0% in Group B (p = 0.037). On multivariate analysis BMI (OR 2.006; 95% CI 1.147-4.985, p = 0.040), small pancreatic duct (OR 2.755; 95% CI 1.589-2.968, p = 0.026) and soft pancreas (OR 2.289; 95% CI 1.126-3.665, p = 0.040) were found to be independent factors for POPF. The median survival for adenocarcinomas was 20 months in Group A and 22 months in Group B, (p = 0.109).

Conclusion: Patients with BMI ≥ 30 are at an increased risk of developing pancreatic fistula following PD. Obesity does not appear to have an impact on long term outcomes in patients undergoing a PD for adenocarcinomas.

Keywords: Obesity; Pancreatic cancer; Pancreatic fistula; Pancreatico-duodenectomy.