Impact of body composition on the development of pancreatic fistula after pancreaticoduodenectomy.

PURPOSE: Postoperative pancreatic fistula (POPF) is a clinically relevant complication of pancreaticoduodenectomy (PD). We focused on the association between body composition and the development of POPF. This study aimed to identify which aspects of body composition have the strongest impact.

METHODS

We retrospectively reviewed the records of 218 patients who underwent PD from 2016 to 2023. We assessed the following aspects of body composition in terms of their predictive value for POPF: body mass index, skeletal muscle index, visceral fat area, subcutaneous fat area, intramuscular adipose tissue content (IMAC), and depth of the pancreas on preoperative computed tomography.

RESULTS

A multivariate analysis revealed that a high visceral fat area, high IMAC, and more deeply positioned pancreas were independent risk factors for POPF. Although the visceral fat-associated aspects of body composition were statistically significant, sarcopenia-associated factors were not. Moreover, in patients with a normal pancreas, a high IMAC and deeper pancreas were independent risk factors for POPF.

CONCLUSIONS

High IMAC and deeper pancreas were significant risk factors for POPF regardless of pancreatic stump texture. Preoperative assessment of body composition factors could be important for predicting POPF after PD and for identifying high-risk patients.