Does preoperative body composition affect survival and postoperative outcomes in patients resected for pancreatic cancer?
Oscar Luong, Hanna SternbyAbstract
Introduction
Pancreatic cancer is one of the deadliest malignancies worldwide and curative surgery comes with a high risk of complications. The impact of preoperative body composition on survival remains unclear. Previous studies have implied that sarcopenia, sarcopenic obesity, myosteatosis and visceral obesity could have a negative influence on patient outcome. In this study, we aim to investigate a possible association between body composition, survival and complications.
Methods
Patients resected for pancreatic adenocarcinoma in southern Sweden between 2010–2024 were enrolled from the pancreatic cancer registry along with patient-related variables. For each patient, a preoperative CT-slide on L3-level was extracted and analyzed with AI-program MosamaticTM to determine body composition together with predefined threshold values. Data was analyzed using person chi square, Fisher exact test, Monte Carlo simulation, Mann Witney, Kaplar Meier with log-rank test and cox regression.
Results
Among the 305 patients who underwent pancreatic surgery, 199 were sarcopenic, 16 were sarcopenic obese, 159 were myosteatotic and 171 had visceral obesity. Median age was 69 years and 52.8% were male. 88.1% received adjuvant therapy. Only myosteatosis significantly reduced overall survival on Kaplan-Meier with log-rank test and univariate cox regression, however no influence was found when analyzed through multivariate analysis. Visceral obesity correlated with major postoperative complications.
Discussion
Our study could not find an association between preoperative body composition and overall survival. However, established cutoff levels for the investigated parameters are lacking and need to be set for better understanding and comparison between studies.