Published online May 15, 2013. doi: 10.4291/wjgp.v4.i2.37
Revised: April 9, 2013
Accepted: April 13, 2013
Published online: May 15, 2013
AIM: To evaluate the impact of body mass index (BMI) on short and long term results after pancreaticoduodenectomies (PD).
METHODS: A consecutive series of PDs performed at the Karolinska University Hospital from 2004 till 2010 were retrieved from our prospective database. The patients were divided by BMI into overweight/obese (O; BMI ≥ 25 kg/m2) and controls (C; BMI < 25 kg/m2). Demographics, peri-operative data, morbidity, mortality, pancreatic fistula (PF) rate, length of stay (LOS), hospital costs, histology, and survival were analyzed. An additional sub analysis of survival was performed in patients with a diagnosis of pancreatic ductal adenocarcinoma (PDAC) and divided in underweight, normal-weight, overweight and obese.
RESULTS: A total of 367 PDs were included (O = 141/C = 226). No differences were found between O and C regarding demographics, peri-operative data, costs, morbidity or mortality. O was associated with higher intra-operative blood loss (1392 ± 115 mL vs 1121 ± 83 mL; P = 0.01), rate of PF (20% vs 9.5%; P = 0.006) and marginally longer LOS (18 ± 0.9 d vs 15 ± 1.1 d; P = 0.05). An increasing risk for PF was observed with increasing BMI. The 1, 3 and 5 years survival rate was similar in O and C in PDAC (68.7%, 26.4% and 8.8% vs 66.1%, 30.9% and 17.9% respectively; P = 0.9). When the survival was analyzed using 4 different categories of BMI (underweight, normal, overweight and obese), a trend was seen toward a difference in survival, with a worse prognosis for the underweight and obese patients compared to normal weight and overweight patients.
CONCLUSION: Overweight increases the risk for intra-operative bleeding and PF, but do not otherwise alter short or long term outcome after PD for pancreatic cancer.
Core tip: In the last decades, the number of overweight individuals has increased dramatically in Western countries. No data are available in the literature that show clearly whether this comorbidity has an impact on short-term or long-term outcomes in these patients or on procedure-related costs. Some studies have shown that pancreatectomies in overweight patients are associated with an increased risk of post-operative complications. The data are even more confusing regarding long-term and oncologic outcomes. In our study, based on a large series of consecutive pancreaticoduodenectomies (PD) performed in a high volume center for pancreatic surgery, we showed that body mass index (BMI) is a risk factor for intra-operative bleeding and post-operative pancreatic fistula, but does not increase the overall morbidity and have no impact on survival of patients with pancreatic ductal adenocarcinoma. Based on these results, BMI should not be considered, per-se, an exclusion criteria for candidates for PD.