Psoas muscle variables and adjuvant chemotherapy-related and survival outcomes following pancreaticoduodenectomy for periampullary malignancy

Table 1 Baseline characteristics of the included patients, mean ± SD/n (%)

Characteristic	Total (n = 148)
Age	68.3 ± 8.29
Gender (male/female)	81 (55)/67 (45)
ASA
1	7 (4.7)
2	62 (42.0)
3	77 (52.0)
4	2 (1.3)
BMI (kg/m2)	26.2 ± 4.0
Neoadjuvant chemotherapy	2 (1.3)
Procedure
PPPD	137 (92.5)
Classical Whipple	11 (7.5)
Type of malignancy
Pancreatic	94 (63.5)
Cholangiocarcinoma	15 (10.1)
Duodenal	9 (6.1)
Ampullary	30 (20.3)
TNM stage
I	23 (15.6)
II	116 (78.3)
III	9 (6.1)
IV	0 (0)
Poor	81 (54.7)
Moderate	59 (39.9)
Well	5 (3.3)
Undifferentiated	2 (1.4)
Unable to assess	1 (0.7)
R status
0	68 (45.9)
1	79 (53.4)
2	1 (0.7)
Number of harvested lymph nodes	20 ± 8.3

ASA: American Society of Anesthesiologists; BMI: Body mass index; PPPD: Pylorus preserving pancreaticoduodenectomy; TNM: Tumor, node, metastasis.

Table 2 Postoperative outcomes, n (%)

Characteristic	Total (n = 148)
Postoperative complications
C-D I	25 (16.9)
C-D II	41 (27.7)
C-D III	8 (5.4)
C-D IV	1 (0.7)
POPF
A	21 (14.2)
B	12 (8.1)
C	0 (0)
Chyle leak	0 (0)
Bile leak	0 (0)
Postoperative hemorrhage	3 (2.0)
Mortality
30-day	0 (0)
90-day	0 (0)
In-hospital	0 (0)
LOS, mean ± SD (days)	14 ± 6.2
Re-operation	0 (0)
Re-admission	18 (12.2)
Survival
1-yaer	126 (85.1)
3-years	44 (29.7)
5-years	19 (19.8)

C-D: Clavien-Dindo; POPF: Postoperative pancreatic fistula; LOS: Length of hospital stay.

Table 3 Multivariable logistic regression analysis of independent variables for prediction of time to adjuvant chemotherapy, completion of adjuvant chemotherapy, 1-year, 3-years and overall survival

Variable	Time to AC		Completion of AC		1-year survival		3-years survival		Overall survival
	Standardized coefficient	P value	Standardized coefficient	P value	Standardized coefficient	P value	Standardized coefficient	P value	Standardized coefficient	P value
PMI	-0.0109	0.2405	-0.0003	0.1985	0.0001	0.3790	0.0001	0.9774	0.3140	0.3065
HUAC	0.5074	0.0005	0.0124	0.0486	0.0005	0.8616	0.0020	0.5941	0.4704	0.9206
Sarcopenia	6.3857	0.1676	0.2114	0.1188	-0.0059	0.9531	0.0551	0.6641	-33.5165	0.8262
Age	0.1439	0.4434	-0.0036	0.5082	-0.0074	0.0689	0.0010	0.8328	-1.6205	0.7927
Octogenarian	2.9289	0.7158	0.2488	0.2923	0.2749	0.1151	0.5160	0.0201	538.2032	0.0433
ASA	1.7999	0.4676	0.0005	0.9941	0.0031	0.9535	0.0326	0.6292	45.9027	0.5729
CR-POPF	7.2686	0.1739	0.1050	0.5017	0.0878	0.4456	0.0525	0.7182	228.5744	0.1931
C-D > III	5.9580	0.3445	0.0764	0.6788	-0.0841	0.5361	-0.0448	0.7943	-106.1970	0.6078
LOS	0.6556	0.0076	-0.0033	0.6392	-0.0010	0.8462	-0.0101	0.1290	-7.6509	0.3385
Cardiac disease	2.8105	0.5780	-0.1286	0.3855	-0.0572	0.5997	-0.2473	0.0747	-291.7777	0.0804
COPD	-9.9204	0.1640	0.4382	0.0368	0.1614	0.2935	0.1030	0.5954	111.0465	0.6344

AC: Adjuvant chemotherapy; PMI: Psoas muscle index; HUAC: Hounsfield unit average calculation; ASA: American Society of Anesthesiologists; CR-POPF: Clinically relevant-postoperative pancreatic fistula; C-D: Clavien-Dindo; LOS: Length of stay; COPD: Chronic obstructive pulmonary disease.

Table 4 Multivariable logistic regression analysis of independent variables for prediction of failure to initiate adjuvant chemotherapy following pancreaticoduodenectomy

Variable	Failure to initiate AC
	Standardized coefficient	P value
PMI	0.0003	0.1041
HUAC	-0.0014	0.6104
Age	-0.0001	0.9826
Octogenarian	-0.4071	0.0009
ASA	-0.0668	0.1881
CR-POPF	0.0612	0.5631
C-D > III	-0.2514	0.0184
LOS	-0.0083	0.0103
Cardiac disease	0.1013	0.3200
COPD	-0.2022	0.0842

AC: Adjuvant chemotherapy; PMI: Psoas muscle index; HUAC: Hounsfield unit average calculation; ASA: American Society of Anesthesiologists; CR-POPF: Clinically relevant-postoperative pancreatic fistula; C-D: Clavien-Dindo; LOS: Length of stay; COPD: Chronic obstructive pulmonary disease.

Table 5 Multivariable logistic regression analysis of independent variables for prediction of failure to complete adjuvant chemotherapy due to mortality toxicity, disease progression, or non-chemotherapy-related complications

Variable	Mortality		Toxicity		Disease progression		NCRC
	Standardized coefficient	P value	Standardized coefficient	P value	Standardized coefficient	P value	Standardized coefficient	P value
PMI	0.0002	0.0651	-0.0001	0.7255	-0.0004	0.7784	0.0002	0.1798
HUAC	-0.0013	0.4073	-0.0059	0.0431	0.0025	0.8818	0.0003	0.8697
Sarcopenia	0.0173	0.7343	-0.0284	0.7622	-0.1182	0.1523	-0.0213	0.7528
Age	0.0006	0.7556	0.0028	0.4599	-0.1658	0.4587	0.0006	0.8234
Octogenarian	-0.0085	0.9228	0.0238	0.8839	-0.0107	0.2495	-0.0770	0.5109
ASA	-0.0165	0.5436	-0.0316	0.5292	-0.1152	0.8092	0.0471	0.1925
CR-POPF	0.0279	0.6328	-0.0923	0.3929	-0.1012	0.2268	0.0568	0.4641
C-D > III	0.0974	0.1593	0.1013	0.4269	0.0051	0.3683	-0.1046	0.2545
LOS	-0.0025	0.3498	0.0043	0.3783	0.0931	0.2442	-0.0035	0.3274
Cardiac disease	0.0469	0.3976	-0.0308	0.7635	-0.0004	0.3024	-0.0833	0.2578
COPD	-0.0491	0.5281	-0.1133	0.4311	0.0025	0.7784	-0.0484	0.6396

NCRC: Non-chemotherapy-related complications; PMI: Psoas muscle index; HUAC: Hounsfield unit average calculation; ASA: American Society of Anesthesiologists; CR-POPF: Clinically relevant-postoperative pancreatic fistula; C-D: Clavien-Dindo; LOS: Length of stay; COPD: Chronic obstructive pulmonary disease.