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 Wolfgang, Timothy M. Pawlik

Research output: Contribution to journalArticle

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 2), 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
Body Mass Index
Survival
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; Pawlik, Timothy M.

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

Research output: Contribution to journalArticle

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 ; 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 2), 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 - Tsai, Susan

AU - Choti, Michael A.

AU - Assumpcao, Lia

AU - Cameron, John L

AU - Gleisner, Ana L.

AU - Herman, Joseph M.

AU - Eckhauser, Frederic

AU - Edil, Barish H.

AU - Schulick, Richard D.

AU - Wolfgang, Christopher

AU - Pawlik, Timothy M.

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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 2), 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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KW - Pancreatic adenocarcinoma

KW - Pancreaticoduodenectomy

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