SARCOPENIA IS AN INDEPENDENT RISK FACTOR FOR DELAYED GASTRIC EMPTYING AFTER PANCREATICODUODENECTOMY

BACKGROUND: Sarcopenia is defined as the degenerative loss of skeletal muscle and can be measured using the cross-sectional diameter of the psoas muscle on computed tomography. Sarcopenia has been associated with a variety of post-operative complications. We propose that sarcopenia acts as an independent factor predictive of delayed gastric emptying (DGE) after elective pancreaticoduodenectomy (PD). METHODS: A retrospective analysis of a prospectively maintained database of all patients undergoing PD at our tertiary hepatobiliary center was performed for the period December 2014 - March 2017. For each patient, the preoperative cross-sectional diameter of the psoas muscle at the upper border of L4 was calculated. Measurements in the lowest third of gender specific groups were considered to be sarcopenic. The presence of DGE, post-operative pancreatic fistulas (POPF) and major postoperative complications graded as Clavien Dindo III or more were included in the analysis. RESULTS: A total of 40 patients were included, 15 (37.5%) of whom were classified as sarcopenic. Comparison between the sarcopenic and non-sarcopenia groups revealed homogeneity in terms of gender, age, BMI and pre-operative albumin levels. DGE occurred in 11 patients (27.5%) of whom 7 were sarcopenic. Significantly more sarcopenic patients suffered from DGE (7/15 vs 4/25, p = 0.042). Major postoperative complications and POPF occurred in 15 patients each (37.5%). Nevertheless, sarcopenia was not significantly associated with POPF or other complications. The presence of sarcopenia was found to have a significant relationship with the incidence of DGE (OR 4.594, 95% CI 1.052-20.057). DISCUSSION: Sarcopenia acted as an independent risk factor predicting DGE after PD but not for POPF or other major postoperative complications.