Consequences of metabolic syndrome on postoperative outcomes after pancreaticoduodenectomy

Table 1 Demographic characteristics n (%)

	Non-MS group (n = 241)	MS group (n = 29)	P value
Preoperative characteristics
Male gender	148 (61)	21 (72)	0.170
Age (yr), mean (range)	62.5 (30.6-88.7)	69.4 (52.1-80.3)	0.003
> 75 yr	8 (28)	42 (17)	0.141
ASA score ≤ 2	204 (85)	22 (76)	0.171
Median BMI (kg/m2)	23.5	27.2	0.001
> 30 kg/m2	11 (5)	6 (21)	0.0001
Diabetes	26 (11)	18 (62)	0.0001
Hypertension	66 (28)	28 (97)	0.0001
Dyslipidemia	33 (14)	25 (86)	0.0001
Cardio-respiratory comorbidity
Coronary heart disease	17 (7)	4 (14)	0.181
COPD	7 (3)	1 (3)	0.608
Alcohol	34 (14)	3 (10)	0.401
Tobacco	45 (19)	3 (10)	0.190
Initial presentation
Jaundice	47 (20)	9 (31)	0.004
Biliary stenting	80 (34)	17 (59)	0.008
Abdominal pain	74 (31)	4 (14)	0.179
Baseline CA 19-9, mean (range)	312.8 (0-5300)	430.4 (35.2-1054)	0.710
Tumor diameter > 30 mm	80 (34)	6 (21)	0.838
Indications
Malignant disease	211 (86)	27 (93)	0.516
Adenocarcinoma	141 (59)	17 (59)	0.842
Malignant ampuloma	25 (10)	2 (7)	0.557
Cholangiocarcinoma	21 (9)	5 (17)	0.142
Endocrine tumor	10 (4)	2 (7)	0.499
Other	14 (6)	1 (3)	0.148
Benign disease	30 (12)	2 (7)	0.385
IPMN	22 (9)	1 (3)	0.302
Other	8 (3)	1 (3)	0.742

MS: Metabolic syndrome; ASA: American society of anesthesiologists; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; IPMN: Intraductal papillary mucinous neoplasm.

Table 2 Intraoperative characteristics n (%)

	Non-MS group (n = 241)	MS group (n = 29)	P value
Soft pancreatic texture	53 (22)	21 (72)	0.0001
Pancreatic duct diameter < 3 mm	84 (35)	13 (45)	0.295
Vein resection	39 (16)	5 (17)	0.560
Visceral resection	21 (9)	3 (10)	0.490
Median surgery duration (mn)	430	462	0.285
Median blood loss (mL)	400	600	0.287
Perioperative transfusion	16%	29%	0.002

MS: Metabolic syndrome.

Table 3 Postoperative outcomes n (%)

	Non-MS group (n = 241)	MS group (n = 29)	P value
Postoperative complications	170 (71)	24 (83)	0.195
Clavien I-II complications	77 (32)	9 (31)	0.639
Clavien III-IV complications	78 (32)	12 (41)	0.123
Postoperative mortality	15 (6)	2 (7)	0.302
Pancreatic fistula	72 (30)	13 (45)	0.079
Grade of pancreatic fistula			0.257
A	16 (22)	4 (31)
B	22 (31)	5 (38)
C	34 (47)	4 (31)
Delayed gastric emptying	12 (5)	1 (3)	0.583
Abdominal collection	54 (22)	7 (24)	0.496
Haemorrhage	44 (18)	6 (21)	0.800
Biliary fistula	16 (7)	1 (3)	0.762
Gastroenteric anastomosis fistula	5 (2)	1 (3)	0.814
Pulmonary complications	35 (15)	8 (28)	0.057
Reoperation	59 (24)	5 (17)	0.921
Hospital stay (d), median	22	25	0.972

MS: Metabolic syndrome.

Table 4 Risk factors of pancreatic fistula n (%)

	No pancreatic fistula (n = 185)	Pancreatic fistula (n = 85)	Univariate analysis	Multivariable analysis
			P value	HR	95%CI	P value
Preoperative characteristics
Male gender	108 (58)	61 (72)	0.023	1.45	0.038-9.204	0.418
Age > 75 yr	33 (18)	17 (20)	0.394
ASA score ≤ 2	161 (87)	65 (76)	0.125
BMI > 30 kg/m2	6 (3)	11 (13)	0.005	2.02	1.034-3.284	0.041
Diabetes	33 (18)	11 (13)	0.193
Hypertension	57 (31)	37 (44)	0.041	1.03	0.005-14.58	0.250
Dyslipidemia	33 (18)	25 (29)	0.132
Metabolic syndrome	16 (9)	13 (15)	0.137
Coronary heart disease	10 (5)	11 (13)	0.049	3.51	0.108-2.071	0.865
COPD	7 (4)	1 (1)	0.443
Alcohol	21 (11)	16 (19)	0.083	0.25	0.024-3.578	0.725
Tobacco	28 (15)	20 (23)	0.125
Malignant disease	165 (89)	73 (86)	0.825
Surgical procedures
Pancreatogastrostomy	76 (41)	33 (39)	0.893
Soft pancreatic texture	42 (23)	32 (38)	0.001	3.37	1.124-3.217	0.001
Pancreatic duct diameter < 3 mm	55 (30)	42 (49)	0.003	1.45	1.045-2.452	0.025
Vein resection	38 (20.5)	6 (7.0)	0.002	2.25	0.045-4.393	0.486
Arterial resection	2 (1.0)	0 (0)	0.925
Visceral resection	17 (9)	7 (8)	0.499
Perioperative transfusion	27 (15)	14 (16)	0.528

MS: Metabolic syndrome; ASA: American society of anesthesiologists; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease.