The effect of visceral fat mass on pancreatic fistula after pancreaticoduodenectomy.

BACKGROUND: Obesity is associated with perioperative complications and has been considered a risk factor for surgical outcomes of patients undergoing abdominal surgery. The aim of this study is to evaluate the impact of the amount of visceral fat on postoperative morbidity of patients who underwent pancreaticoduodenectomy (PD).

METHODS: We reviewed 181 patients who underwent surgery for periampullary lesions at the Department of Surgery, Gangnam Severance Hospital, Yonsei University Health System between January 2003 and June 2010. The visceral fat area (VFA) and subcutaneous fat area were calculated by computed tomography software.

RESULTS: The mean body mass index (BMI) was 23.4 kg/m(2) (±3.1 kg/m(2)), and the mean VFA was 94.4 cm(2) (±49.5 cm(2)). The mean intraoperative blood loss, and the incidence of clinically relevant pancreatic fistula (grade B/C) and clinically relevant delayed gastric emptying (grade B/C) were significantly higher in the high-VFA group (≥100 cm(2)). In univariate analysis, the incidence of clinically relevant pancreatic fistula (grade B/C) was significantly higher in the high-BMI group (≥25 kg/m(2)), the high-VFA group(≥100 cm(2)), the large intraoperative blood loss and transfusion group, and in patients with pathology of nonpancreatic origin (ampulla, bile duct, or duodenum). In multivariate analysis, the high-VFA group (≥100 cm(2)) and patients with pathology of nonpancreatic origin were identified as independent factors for clinically relevant pancreatic fistula.

CONCLUSION: VFA is a better indicator for the development of pancreatic fistula after PD than BMI. High VFA (≥100 cm(2)) is a risk factor for developing a pancreatic fistula after PD.