Deeksha Kapoor, Azhar Perwaiz, Amanjeet Singh and Adarsh Chaudhary*
Background Complications after Pancreatoduodenectomy (PD) are not unusual, making it worthwhile to search for factors responsible for them. Pancreatic gland morphology (PGM) and the patient’s body composition (BCA) can both affect postoperative outcomes. This study was undertaken to study the differential role of PGM and BCA on postoperative outcomes after PD. Methods Retrospective analysis of 457 patients who underwent PD. Preoperative computed tomography scans were used to assess PGM and BCA. The impact of PGM and BCA was studied on major complications (MC) and clinically relevant pancreatic fistula (CRPF). Results Major complications, Clavien Dindo ≥3, were seen in 60(13.1%) patients and CRPF in 43(9.4%). On multivariable logistic regression, a high pancreatic cut surface area/main pancreatic duct (SA/MPD) was an independent predictor of MC (OR 2.842, p<0.001), along with respiratory comorbidity, preoperative cholangitis and elevated serum creatinine. Low muscle density (PMD) (OR 2.466, p=0.008) and high SA/MPD (OR 3.373, p=0.001) were risk factors for CRPF. Thirty-day mortality (30DM) was 3.9%. SA/MPD was also a risk factor for 30DM and pancreatectomy-specific complications (PSC). Visceral fat area/total abdominal muscle area was a predictor of prolonged hospital stay. Conclusion The parameter SA/MPD consistently predicted postoperative outcomes, predicting MC, CRPF, PSC and 30DM.
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