Impact of Obesity on Perioperative Outcomes and Survival Following Pancreaticoduodenectomy for Pancreatic Cancer: A Large Single-Institution Study |
| |
Authors: | Susan Tsai Michael A. Choti Lia Assumpcao John L. Cameron Ana L. Gleisner Joseph M. Herman Frederic Eckhauser Barish H. Edil Richard D. Schulick Christopher L. Wolfgang Timothy M. Pawlik |
| |
Affiliation: | 1. Department of Surgery, Johns Hopkins Medical Institutions, Harvey 611, 600N Wolfe Street, Baltimore, MD, 21287, USA 2. Department of Radiation Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
|
| |
Abstract: | Background To examine the effect of body mass index (BMI) on clinicopathologic factors and long-term survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma. Methods Data on BMI, weight loss, operative details, surgical pathology, and long-term survival were collected on 795 patients who underwent pancreaticoduodenectomy. Patients were categorized as obese (BMI?>?30 kg/m2), overweight (BMI 25 to <30 kg/m2), or normal weight (BMI?25 kg/m2) and compared using univariate and multivariate analyses. Results At the time of surgery, 14% of patients were obese, 33% overweight, and 53% normal weight. Overall, 32% of patients had preoperative weight loss of >10%. There were no differences in operative times among the groups; however, higher BMI was associated with increased risk of blood loss (P?0.001) and pancreatic fistula (P?=?0.01). On pathologic analysis, BMI was not associated with tumor stage or number of lymph nodes harvested (both P?>?0.05). Higher BMI patients had a lower incidence of a positive retroperitoneal/uncinate margin versus normal weight patients (P?=?0.03). Perioperative morbidity and mortality were similar among the groups. Obese and overweight patients had better 5-year survival (22% and 22%, respectively) versus normal weight patients (15%; P?=?0.02). After adjusting for other prognostic factors, as well as preoperative weight loss, higher BMI remained independently associated with improved cancer-specific survival (overweight: hazard ratio, 0.68; obese: hazard ratio, 0.72; both P?0.05). Conclusion Obese patients had similar tumor-specific characteristics, as well as perioperative outcomes, compared with normal weight patients. However, obese patients undergoing pancreaticoduodenectomy for pancreatic cancer had an improved long-term survival independent of known clinicopathologic factors. |
| |
Keywords: | |
本文献已被 SpringerLink 等数据库收录! |
|