Preoperative sarcopenia predicts major postoperative morbidity in patients undergoing pancreatic surgery for chronic pancreatitis.

BACKGROUND

Sarcopenia, defined as the loss of skeletal muscle mass and function, is associated with adverse outcomes in major surgery. However, its prevalence and impact on outcomes in patients with chronic pancreatitis (CP) undergoing pancreatic surgeries remain unknown.

METHODS

A retrospective analysis of adult patients with CP undergoing nontotal pancreatectomy with islet autotransplantation (TPIAT) surgeries (Whipple, Puestow, Frey, or distal pancreatectomy) from 2015 to 2025. Patients who underwent TPIAT were excluded. Sarcopenia was defined using computed tomography (CT)-based skeletal muscle index at the L3 vertebra with validated sex-specific cutoffs. The primary outcome was major morbidity (Clavien-Dindo ≥ IIIa and Comprehensive Complication Index > 26.2). Secondary outcomes included specific complications, hospital stay, readmission, mortality, and 1-year metabolic outcomes.

RESULTS

Of 65 patients, 20 (30.8%) were sarcopenic. Patients with sarcopenia had a lower body mass index (BMI) (21.2 vs 25.1 kg/m²; P =.003), though 20% had a BMI ≥ 25 kg/m². Patients with sarcopenia experienced dramatically higher complication rates: any complication (85% vs 37.8%; P <.001), major morbidity (80% vs 20%; P <.001), and 30-day readmission (55% vs 11.1%; P <.001). Hospital stay was longer (10 vs 7 days; P =.004). In-hospital mortality occurred exclusively in patients with sarcopenia (20% vs 0%; P =.007). On multivariable analysis, sarcopenia was independently associated with major morbidity (adjusted odds ratio 97.6; P <.001). One-year metabolic outcomes were comparable between groups.

CONCLUSION

Sarcopenia affects one-third of patients with CP undergoing non-TPIAT CP surgeries and is associated with increased perioperative morbidity and mortality. CT-based sarcopenia assessment should be integrated into preoperative risk stratification, and surgery should be pursued only after aggressive rehabilitation.