Hajibandeh S, Hajibandeh S, Mckittrick H, Imrani U, Varghese A, Balasubramaniam R, Durkin D, Athwal TS. Psoas muscle variables and adjuvant chemotherapy-related and survival outcomes following pancreaticoduodenectomy for periampullary malignancy. World J Gastrointest Surg 2026; 18(2): 114743 [DOI: 10.4240/wjgs.v18.i2.114743]
Corresponding Author of This Article
Shahin Hajibandeh, FRC, Senior Researcher, Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom. shahin_hajibandeh@yahoo.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shahin Hajibandeh, Hamish Mckittrick, Damien Durkin, Tejinderjit S Athwal, Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, United Kingdom
Shahin Hajibandeh, Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom
Shahab Hajibandeh, Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal Infirmary Hospital, Manchester M13 9WL, United Kingdom
Usman Imrani, Abin Varghese, Ravivarma Balasubramaniam, Department of Radiology, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, United Kingdom
Author contributions: Hajibandeh S (the first author) did conception and design; Mckittrick H, Imrani U, and Varghese A performed literature search and data extraction; Hajibandeh S (the first author) and Hajibandeh S (the second author) contributed to analysis and writing the manuscript. All authors approved the final version to publish.
Institutional review board statement: This study had a retrospective design involving non-identifiable data from hospital databases, approval by Ethics Committees was not needed.
Informed consent statement: Considering that this study had a retrospective design involving non-identifiable data from hospital databases, patient consent was not needed.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data used in this study will be available on request.
Corresponding author: Shahin Hajibandeh, FRC, Senior Researcher, Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom. shahin_hajibandeh@yahoo.com
Received: September 28, 2025 Revised: November 6, 2025 Accepted: December 16, 2025 Published online: February 27, 2026 Processing time: 152 Days and 17.6 Hours
Abstract
BACKGROUND
Early skeletal muscle wasting has been demonstrated to be associated with chemotherapy-related toxicity in patients with cancer. Hounsfield unit average calculation (HUAC) or psoas muscle index (PMI) can be used to diagnose skeletal muscle wasting radiologically by calculations involving psoas muscle area.
AIM
To evaluate ability of HUAC and PMI in predicting adjuvant chemotherapy (AC)-related and survival outcomes following pancreaticoduodenectomy for periampullary malignancy.
METHODS
A retrospective study of patients who underwent pancreaticoduodenectomy for periampullary malignancy was conducted. HUAC and PMI were determined from preoperative computed tomography scans. Time to AC, completion of AC, survival, failure to initiate AC, mortality during AC, AC-related toxicity, cancer progression during AC and non-chemotherapy-related complications were the outcome measures.
RESULTS
A total of 148 patients were included of whom 62.2% completed AC. The AC was terminated due to toxicity in 33.9%, cancer progression in 25.0%, non-chemotherapy-related complications in 16.1%, or poor performance status in 3.5% of the patients. The 1-,3-,5-years survival rates were 85.1%, 29.7% and 19.9%, respectively. The overall median survival was 22.6 (76.8) months. HUAC was an independent predictor of time to AC (P = 0.0005), AC-related toxicity (P = 0.0431), and completion of AC (P = 0.0486). However, HUAC did not predict 1-year (P = 0.8616), 3-years (P = 0.5941) or overall (P = 0.9206) survival. Being an octogenarian (P = 0.0009), Clavien-Dindo > III (P = 0.0184), and length of hospital stay (P = 0.0103) were independent predictors of failure to initiate AC. Moreover, being an octogenarian was an independent predictor of 3-years (P = 0.0201) and overall (P = 0.0433) survival. PMI did not predict any of the outcome measures.
CONCLUSION
Unlike PMI, preoperative HUAC, determined from psoas muscle area and density, may predict time to AC, AC-related toxicity and completion of AC following pancreaticoduodenectomy for periampullary cancers. However, its ability to predict survival should be evaluated by future research.
Core Tip: Preoperative Hounsfield unit average calculation, determined from psoas muscle area and density, may predict time to adjuvant chemotherapy (AC), AC-related toxicity and completion of AC following pancreaticoduodenectomy for periampullary cancers. However, its ability to predict survival should be evaluated by future research. This study aims to evaluate ability of Hounsfield unit average calculation and psoas muscle index in predicting AC-related and survival outcomes following pancreaticoduodenectomy for periampullary malignancy.
