Surgery
Volume 148, Issue 1 , Pages 15-23 , July 2010

Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy

  • Sébastien Gaujoux, MD

      Affiliations

    • Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France
  • ,
  • Alexandre Cortes, MD

      Affiliations

    • Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France
  • ,
  • Anne Couvelard, MD, PhD

      Affiliations

    • Department of Pathology, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France
  • ,
  • Séverine Noullet, MD

      Affiliations

    • Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France
  • ,
  • Laurent Clavel, MSc

      Affiliations

    • AP-HP, Beaujon Hospital, Clichy, and University Paris 7, and Institut National de la Statistique et des Etudes Economiques, Paris, France
  • ,
  • Vinciane Rebours, MD

      Affiliations

    • Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France
  • ,
  • Philippe Lévy, MD

      Affiliations

    • Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France
  • ,
  • Alain Sauvanet, MD

      Affiliations

    • Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France
  • ,
  • Philippe Ruszniewski, MD

      Affiliations

    • Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France
  • ,
  • Jacques Belghiti, MD

      Affiliations

    • Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France
    • Corresponding Author InformationReprint requests: Jacques Belghiti, MD, Department of Hepatobiliary and Pancreatic Surgery, Hospital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France.

,Accepted 7 December 2009.

References 

  1. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244:10–15
  2. De Oliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931–939
  3. Pratt WB, Callery MP, Vollmer CM. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg. 2008;32:419–428
  4. Kazanjian KK, Hines OJ, Eibl G, Reber HA. Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients. Arch Surg. 2005;140:849–856
  5. Munoz-Bongrand N, Sauvanet A, Denys A, Sibert A, Vilgrain V, Belghiti J. Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg. 2004;199:198–203
  6. de Castro SM, Busch OR, van Gulik TM, Obertop H, Gouma DJ. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg. 2005;92:1117–1123
  7. Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg. 2005;242:767–773
  8. Yeo CJ, Cameron JL, Maher MM, Sauter PK, Zahurak ML, Talamini MA, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg. 1995;222:580–592
  9. Connor S, Alexakis N, Garden OJ, Leandros E, Bramis J, Wigmore SJ. Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery. Br J Surg. 2005;92:1059–1067
  10. Muscari F, Suc B, Kirzin S, Hay JM, Fourtanier G, Fingerhut A, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients. Surgery. 2006;139:591–598
  11. Lin JW, Cameron JL, Yeo CJ, Riall TS, Lillemoe KD. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg. 2004;8:951–959
  12. Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ, et al. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg. 2007;246:1058–1064
  13. Olsen TS. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Pathol Microbiol Scand A. 1978;86A:367–373
  14. Sledzianowski JF, Duffas JP, Muscari F, Suc B, Fourtanier F. Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy. Surgery. 2005;137:180–185
  15. Humar A, Ramcharan T, Kandaswamy R, Gruessner RW, Gruessner AG, Sutherland DE. The impact of donor obesity on outcomes after cadaver pancreas transplants. Am J Transplant. 2004;4:605–610
  16. World Health Organization. Physical status: the use and the interpretation of anthropometry. Report of a WHO expert committee. World Health Organization Technical Report Series No. 854. Geneva (Switzerland): World Health Organization; 1995;1-452
  17. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13
  18. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–768
  19. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–25
  20. Ammann RW, Heitz PU, Kloppel G. Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology. 1996;111:224–231
  21. Sokal RR, Rohlf FJ. Biometry: the principles and practice of statistics in biological research. 3rd ed.. New York: Freeman; 1994;
  22. Al Sharaf K, Ihse I, Dawiskiba S, Andren-Sandberg A. Characteristics of the gland remnant predict complication after subtotal pancreatectomy. Dig Surg. 1996;14:101–106
  23. Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg. 2007;11:1451–1459
  24. Yeo CJ. Does prophylactic octreotide benefit patients undergoing elective pancreatic resection?. J Gastrointest Surg. 1999;3:223–224
  25. Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg. 1995;221:635–648
  26. Strasberg SM, Drebin JA, Mokadam NA, Green DW, Jones KL, Ehlers JP, et al. Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg. 2002;194:746–760
  27. Rosso E, Casnedi S, Pessaux P, Oussoultzoglou E, Panaro F, Mahfud M, et al. The role of “fatty pancreas” and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg. 2009;13:1845–1851
  28. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–1727
  29. Gendall KA, Raniga S, Kennedy R, Frizelle FA. The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum. 2007;50:2223–2237
  30. Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg. 2005;92:1103–1109
  31. Vetelainen R, van Vliet A, Gouma DJ, van Gulik TM. Steatosis as a risk factor in liver surgery. Ann Surg. 2007;245:20–30
  32. McCormack L, Petrowsky H, Jochum W, Furrer K, Clavien PA. Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Ann Surg. 2007;245:923–930
  33. Vetelainen R, van Vliet AK, van Gulik TM. Severe steatosis increases hepatocellular injury and impairs liver regeneration in a rat model of partial hepatectomy. Ann Surg. 2007;245:44–50
  34. Martinez J, Johnson CD, Sanchez-Paya J, de Madaria E, Robles-Diaz G, Perez-Mateo M. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology. 2006;6:206–209
  35. Funnell IC, Bornman PC, Weakley SP, Terblanche J, Marks IN. Obesity: an important prognostic factor in acute pancreatitis. Br J Surg. 1993;80:484–486
  36. Bentrem DJ, Yeh JJ, Brennan MF, Kiran R, Pastores SM, Halpern NA, et al. Predictors of intensive care unit admission and related outcome for patients after pancreaticoduodenectomy. J Gastrointest Surg. 2005;9:1307–1312
  37. Mathur A, Marine M, Lu D, Swartz-Basile DA, Saxena R, Zyromski NJ, et al. Nonalcoholic fatty pancreas disease. HPB. 2007;9:312–318
  38. Ogilvie R. The islands of the Langerhans in 19 cases of obesity. J Pathol. 1933;473–481
  39. Molinari E, Bassi C, Salvia R, Butturini G, Crippa S, Talamini G, et al. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg. 2007;246:281–287
  40. Peng SY, Wang JW, Lau WY, Cai XJ, Mou YP, Liu YB, et al. Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg. 2007;245:692–698
  41. House MG, Fong Y, Arnaoutakis DJ, Sharma R, Winston CB, Protic M, et al. Preoperative predictors for complications after pancreaticoduodenectomy: Impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12:270–278
  42. Williams TK, Rosato EL, Kennedy EP, Chojnacki KA, Andrel J, Hyslop T, et al. Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg. 2009;208:210–217
  43. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48

 S.G. and A.C. contributed equally to this work.

PII: S0039-6060(09)00797-1

doi: 10.1016/j.surg.2009.12.005

Surgery
Volume 148, Issue 1 , Pages 15-23 , July 2010