Visceral Adipose Tissue and Skeletal Muscle Index Distribution Predicts Severe Pancreatic Fistula Development After Pancreaticoduodenectomy

BACKGROUND/AIM: In this study, we investigated the effect of body composition on pancreatic fistula (PF) development after pancreaticoduodenectomy (PD). MATERIALS AND METHODS: All consecutive patients with pancreatic and extrahepatic biliary malignancy following PD who were treated between 2006 and 2016 were enrolled. RESULTS: PF developed in 30.3% of cases (30/99 patients), including a grade B PF in 25.3% of cases (25/99 patients) and a grade C PF in 5.1% of cases (5/99 patients). Univariate analysis identified that body mass index ≥25 kg/m2, visceral adipose tissue area (VATA)/skeletal muscle index (SMI) ≥2.0, pancreatic duct diameter ≤3 mm, and drain amylase concentration (Amy) on postoperative day (POD) 1 ≥5000 U/L were significantly associated with PF (grade B, C) after PD. Multivariate analysis indicated that VATA/SMI ≥2.0 (p=0.009), pancreatic duct diameter ≤3 mm (p=0.003), and drain Amy on POD1 ≥5000 U/L (p=0.032) were independent risk factors for PF. CONCLUSION: Elevated VATA/SMI was the only preoperative key factor for PF after PD.