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INTRODUCTION: The obesity epidemic coupled with epidemiologic evidence of a link between pancreatic cancer and obesity has raised the interest in the impact of BMI (body mass index) on outcomes for patients undergoing curative resection for pancreatic ductal adenocarcinoma.HYPOTHESIS: Obesity increases operative time and blood loss, increases aggressiveness of pancreatic cancer, and decreases overall survival.AIM: To determine effect of obesity on outcome of patients undergoing curative resection of pancreatic ductal adenocarcinoma.METHODS: All consecutive patients undergoing ‘curative’ (R0,R1) pancreatoduodenectomy (PD) for pancreatic adenocarcinoma from 1981 to 2007 were categorized into four groups according to their BMI (<25, 25 to <29.9, 30 to <34.9 and ≥35). Association of BMI groups with peri-operative variables (operating time, blood loss, complications, and in-hospital mortality) pathologic characteristics (tumor size, tumor stage, differentiation, lymph nodal status, and R0 status), and long-term overall and disease-free survival were evaluated using Kruskal-Wallis and chi-square tests, logistic regression, and Cox proportional hazards regression. A second set of analyses were performed by dichotomizing patients into morbidly obese (BMI ≥35) in comparison to the rest.RESULTS: Of the 586 patients studied, there were 232 (40%) with BMI <25, 232 (40%) with BMI 25 to <29.9, 89 (15%) with BMI 30 to <34.9, and 33 (6%) with BMI ≥35. Operating time and intra-operative blood loss increased directly with BMI (P<0.003 each), although none of the remaining peri-operative features differed among BMI groups. There were no associations between BMI and the pathologic features studied. In particular, BMI was not associated with lymph nodal status even after adjusting for tumor size and the number of lymph nodes resected. Most importantly, Cox regression did not demonstrate any association between BMI and overall or disease-free survival. All the analyses were then repeated for the morbidly obese group and the results were similar. CONCLUSIONS: BMI (and morbid obesity) does not influence long-term outcomes for patients undergoing PD for pancreatic adenocarcinoma. Surgeons should however be vigilant of the greater risk of peri-operative blood loss with increasing BMI, which may lead to serious short- and long-term consequences.