PRE-OPERATIVE WEIGHT LOSS - FRIEND OR FOE IN PATIENTS UNDERGOING MAJOR PANCREATIC RESECTION? AN ACS-NSQIP ANALYSIS
Andrew B. Crocker*, Asad Azim, Efrat Dotan, Joshua Meyer, Igor Astsaturov, Sanjay S. Reddy
Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA
Introduction:
Pre-Operative weight loss (WL) has been identified as a significant predictor of adverse outcomes after gastrointestinal surgery. However, the association between preoperative weight loss and the development of pancreatic fistula remains unclear. Therefore, in this study we aim to analyze the effect of preoperative weight loss on the development of pancreatic fistula.
Methods
We performed 5-year retrospective analysis of 2014-2019 NSQIP database of all patients who underwent major pancreatic resection. Patients were categorized into two groups, preoperative weight loss (WL) vs no preoperative weight loss (NWL). Where weight loss was defined as >10% un-intentional reduction in weight within 6 months prior to surgery. Multivariate logistic regression analysis was performed controlling for age, gender, race, type of procedure, operative approach, gland texture, duct size and neoadjuvant chemo and radiation therapy.
Results
A total of 29,351 patients underwent major pancreatic resections (pancreatico-duodenectomy: 21,059 (71.7%), distal Pancreatectomy: 8,292 (28.3%)). Median age was 66 IQR [57-73], 51% were male. 3,617(12.3%) patients reported to have preoperative weight loss. Post-operative course was complicated by pancreatic fistula in 5,540 (18.9%) patients. (WL: 14% vs NWL: 19.6; p<0.001). Overall 30-day mortality rate was 1.3%. On multivariate regression, the WL group had 27% lower odds of developing pancreatic fistula (OR, 0.73; CI: 0.66 – 0.81), 35% more likely to have a firm gland intraoperatively (OR, 1.35; CI: 1.25 – 1.46), and 36% more likely to be discharged to rehab or nursing facility (OR, 1.36; CI: 1.21 – 1.52). However, preoperative WL was not a significant predictor of perioperative mortality (OR:1.25; CI: 0.95 - 1.68).
Conclusion:
Traditionally preoperative weight loss is considered as surrogate of nutritional status and has been known to adversely affect post-operative outcomes. To the contrary, our findings suggest that perioperative weight loss may be independently associated with lower odds of developing pancreatic fistula in patients undergoing major pancreatic resection. Additional analysis is needed to better understand the effect of weight loss on fistula formation in patients undergoing major pancreatic surgery.
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