Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer

A large single-institution study

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

Research output: Contribution to journalArticle

61 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1143-1150
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume14
Issue number7
DOIs
StatePublished - 2010

Fingerprint

Pancreaticoduodenectomy
Pancreatic Neoplasms
Obesity
Survival
Body Mass Index
Weights and Measures
Weight Loss
Surgical Pathology
Operative Time
Neoplasms
Adenocarcinoma
Morbidity

Keywords

  • Obesity
  • Outcomes
  • Pancreatic adenocarcinoma
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology
  • Medicine(all)

Cite this

Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer : A large single-institution study. / Tsai, Susan; Choti, Michael A.; Assumpcao, Lia; Cameron, John L.; Gleisner, Ana L.; Herman, Joseph M.; Eckhauser, Frederic; Edil, Barish H.; Schulick, Richard D.; Wolfgang, Christopher L.; Pawlik, Timothy M.

In: Journal of Gastrointestinal Surgery, Vol. 14, No. 7, 2010, p. 1143-1150.

Research output: Contribution to journalArticle

Tsai, S, Choti, MA, Assumpcao, L, Cameron, JL, Gleisner, AL, Herman, JM, Eckhauser, F, Edil, BH, Schulick, RD, Wolfgang, CL & Pawlik, TM 2010, 'Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer: A large single-institution study', Journal of Gastrointestinal Surgery, vol. 14, no. 7, pp. 1143-1150. https://doi.org/10.1007/s11605-010-1201-3
Tsai, Susan ; Choti, Michael A. ; Assumpcao, Lia ; Cameron, John L. ; Gleisner, Ana L. ; Herman, Joseph M. ; Eckhauser, Frederic ; Edil, Barish H. ; Schulick, Richard D. ; Wolfgang, Christopher L. ; Pawlik, Timothy M. / Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer : A large single-institution study. In: Journal of Gastrointestinal Surgery. 2010 ; Vol. 14, No. 7. pp. 1143-1150.
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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.",
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AU - Cameron, John L.

AU - Gleisner, Ana L.

AU - Herman, Joseph M.

AU - Eckhauser, Frederic

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AB - 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.

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