The effect of sarcopenia and sarcopenic obesity after pancreaticoduodenectomy in patients with pancreatic head cancer

Preoperative nutritional status may reflect outcomes after pancreatoduodenectomy (PD) in patients with pancreatic head cancer (PHC). Recently, several studies have reported that sarcopenia and sarcopenic obesity (SO) could worsen postoperative complications or decreased overall survival (OS) after PD. This study aims to evaluate the effect of preoperative sarcopenia and SO following PD in pancreas head cancer (PHC). Preoperative sarcopenia and SO was assessed in 548 consecutive patients undergoing PD for PHC at Samsung Medical Centre between 2007 and 2016. The visceral adipose tissue-to-skeletal muscle ratio was calculated from cross-sectional visceral fat and muscle areas on preoperative CT images. The OS and rate of clinically-relevant postoperative pancreatic fistula (CR-POPF) among postoperative complications were extracted from prospectively maintained databases. Preoperative sarcopenia was present in 252 patients (45.9%). The 5-year survival rates of patients with sarcopenia and non-sarcopenia were 28.4% and 23.4%, respectively (P = 0.046). And preoperative SO was present in 202 patients (36.9%). After multivariate analysis, the presence of SO was the only independent risk factor for CR-POPF [odds ratio (OR), 2.561, 95% confidence interval (CI), 1.179���5.564, P = 0.018]. Sarcopenia can be a risk factor affecting decreased OS after PD in patients with PHC. SO is the only predictive factor for CR-POPF after PD in patients with PHC. Preoperative SO measurements may stratify patients into risk categories for POPF. More observational studies are needed to evaluate the effect of sarcopenia and SO on survival after PD.Maste