Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3142
Peer-review started: January 14, 2017
First decision: February 23, 2017
Revised: March 3, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: May 7, 2017
Processing time: 112 Days and 23.2 Hours
To analyze immediate postoperative outcomes after pancreaticoduodenectomy regarding metabolic syndrome.
In two academic centers, postoperative outcomes of patients undergoing pancreaticoduodenectomy from 2002 to 2014 were prospectively recorded. Patients presenting with metabolic syndrome [defined as at least three criteria among overweight (BMI ≥ 28 kg/m²), diabetes mellitus, arterial hypertension and dyslipidemia] were compared to patients without metabolic syndrome.
Among 270 consecutive patients, 29 (11%) presented with metabolic syndrome. In univariable analysis, patients with metabolic syndrome were significantly older (69.4 years vs 62.5 years, P = 0.003) and presented more frequently with soft pancreas (72% vs 22%, P = 0.0001). In-hospital morbidity (83% vs 71%) and mortality (7% vs 6%) did not differ in the two groups so as pancreatic fistula rate (45% vs 30%, P = 0.079) and severity of pancreatic fistula (P = 0.257). In multivariable analysis, soft pancreas texture (P = 0.001), pancreatic duct diameter < 3 mm (P = 0.025) and BMI > 30 kg/m² (P = 0.041) were identified as independent risk factors of pancreatic fistula after pancreaticoduodenectomy, but not metabolic syndrome.
In spite of logical reasoning and appropriate methodology, present series suggests that metabolic syndrome does not jeopardize postoperative outcomes after pancreaticoduodenectomy. Therefore, definition of metabolic syndrome seems to be inappropriate and fatty pancreas needs to be assessed with an international consensual histopathological classification.
Core tip: As metabolic syndrome is related to fatty pancreas and fatty pancreas is related to pancreatic fistula, postoperative morbi-mortality should theoretically increase in patient with metabolic syndrome and undergoing pancreaticoduodenectomy. In two academic centers, postoperative outcomes of 270 consecutive patients undergoing pancreaticoduodenectomy were retrospectively compared in regards of metabolic syndrome. In multivariable analysis, soft pancreas texture (P = 0.001), pancreatic duct diameter < 3 mm (P = 0.025) and BMI > 30 kg/m² (P = 0.041) were identified as independent risk factors of pancreatic fistula after pancreaticoduodenectomy, but not metabolic syndrome. The present series suggests that metabolic syndrome does not jeopardize postoperative outcomes after pancreaticoduodenectomy.