Impact of the preoperative body composition indexes on intraoperative blood loss in patients undergoing pancreatoduodenectomy.
Aged
Blood Loss, Surgical
/ statistics & numerical data
Body Composition
Female
Humans
International Normalized Ratio
Intraoperative Period
Male
Middle Aged
Neoadjuvant Therapy
Pancreaticoduodenectomy
/ adverse effects
Preoperative Period
Psoas Muscles
/ diagnostic imaging
Regression Analysis
Retrospective Studies
Serum Albumin
Subcutaneous Fat
/ diagnostic imaging
Tomography, X-Ray Computed
Psoas muscle index
Sarcopenia
Serum albumin
Visceral to subcutaneous adipose tissue area ratio
Journal
Surgery today
ISSN: 1436-2813
Titre abrégé: Surg Today
Pays: Japan
ID NLM: 9204360
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
25
05
2020
accepted:
07
06
2020
pubmed:
22
6
2020
medline:
16
6
2021
entrez:
22
6
2020
Statut:
ppublish
Résumé
This study sought to identify any significant predictors of blood loss during pancreatoduodenectomy (PD) among preoperative variables, including the body composition indexes. The preoperative data of patients undergoing PD were retrospectively reviewed. The objective variable was the percentage of blood loss during PD to the estimated circulating blood volume (proportional blood loss: PBL). The circulating blood volume was estimated using Nadler's formula. The total psoas area, average Hounsfield units of psoas area (psoas muscle density: PMD), and visceral to subcutaneous adipose tissue area ratio (VSR) were measured at the third vertebra using preoperative plain computed tomography images. A univariate analysis and multiple linear regression analysis for PBL were conducted using the preoperative variables. A total of 415 patients were analyzed. The median PBL was 24.5%. The PMD (coefficient - 0.267; 95% CI - 0.518, - 0.015), VSR (coefficient 2.719; 95% CI 0.238, 5.201), serum albumin level (coefficient - 8.458; 95% CI - 13.02, - 3.898), neoadjuvant therapy (coefficient 9.605; 95% CI 1.722, 17.49), and prothrombin time-international normalized ratio (PT-INR, coefficient 38.63; 95% CI 10.94, 66.31) were independently associated with PBL. The preoperative PMD, VSR, serum albumin level, neoadjuvant therapy, and PT-INR independently affected PBL. These factors could therefore be potential targets to reduce blood loss during PD.
Identifiants
pubmed: 32564145
doi: 10.1007/s00595-020-02054-y
pii: 10.1007/s00595-020-02054-y
doi:
Substances chimiques
Serum Albumin
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
52-60Références
Braga M, Capretti G, Pecorelli N, Balzano G, Doglioni C, Ariotti R, et al. A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg. 2011;254:702–7 (discussion 7–8).
pubmed: 22042466
Ross A, Mohammed S, Vanburen G, Silberfein EJ, Artinyan A, Hodges SE, et al. An assessment of the necessity of transfusion during pancreatoduodenectomy. Surgery. 2013;154:504–11.
pubmed: 23972656
Seykora TF, Ecker BL, McMillan MT, Maggino L, Beane JD, Fong ZV, et al. The beneficial effects of minimizing blood loss in pancreatoduodenectomy. Ann Surg. 2019;270:147–57.
pubmed: 29489483
Kazanjian KK, Hines OJ, Duffy JP, Yoon DY, Cortina G, Reber HA. Improved survival following pancreaticoduodenectomy to treat adenocarcinoma of the pancreas: the influence of operative blood loss. Arch Surg. 2008;143:1166–71.
pubmed: 19075167
Sutton JM, Kooby DA, Wilson GC, Squires MH 3rd, Hanseman DJ, Maithel SK, et al. Perioperative blood transfusion is associated with decreased survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma: a multi-institutional study. J Gastrointest Surg. 2014;18:1575–87.
pubmed: 24944151
Maeta T, Ebata T, Hayashi E, Kawahara T, Mizuno S, Matsumoto N, et al. Pancreatoduodenectomy with portal vein resection for distal cholangiocarcinoma. Br J Surg. 2017;104:1549–57.
pubmed: 28782798
Rystedt J, Tingstedt B, Ansorge C, Nilsson J, Andersson B. Major intraoperative bleeding during pancreatoduodenectomy—preoperative biliary drainage is the only modifiable risk factor. HPB. 2019;21:268–74.
pubmed: 30170978
Kirihara Y, Takahashi N, Hashimoto Y, Sclabas GM, Khan S, Moriya T, et al. Prediction of pancreatic anastomotic failure after pancreatoduodenectomy: the use of preoperative, quantitative computed tomography to measure remnant pancreatic volume and body composition. Ann Surg. 2013;257:512–9.
pubmed: 23241871
Pecorelli N, Carrara G, De Cobelli F, Cristel G, Damascelli A, Balzano G, et al. Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery. Br J Surg. 2016;103:434–42.
pubmed: 26780231
Nishida Y, Kato Y, Kudo M, Aizawa H, Okubo S, Takahashi D, et al. Preoperative sarcopenia strongly influences the risk of postoperative pancreatic fistula formation after pancreaticoduodenectomy. J Gastrointes Surg. 2016;20:1586–94.
Takagi K, Yoshida R, Yagi T, Umeda Y, Nobuoka D, Kuise T, et al. Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy. BMC Surg. 2017;17:64.
pubmed: 28549466
pmcid: 5446724
Shintakuya R, Sasaki M, Nakamitsu A, Kohyama M, Tazaki T, Sugiyama Y, et al. Sarcopenia is an independent predictor of delayed gastric emptying following pancreaticoduodenectomy: a retrospective study. ANZ J Surg. 2019;89:E433–7.
pubmed: 31452323
Hamaguchi Y, Kaido T, Okumura S, Fujimoto Y, Ogawa K, Mori A, et al. Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation. Liver Transplant. 2014;20:1413–9.
Chen JS, Huang JQ, Chen XL, Zhan GF, Feng JT. Risk factors associated with intraoperative major blood loss during resection of hepatocellular carcinoma. Hepatogastroenterology. 2015;62:790–3.
pubmed: 26902002
Egenvall M, Morner M, Pahlman L, Gunnarsson U. Degree of blood loss during surgery for rectal cancer: a population-based epidemiologic study of surgical complications and survival. Colorectal Dis. 2014;16:696–702.
pubmed: 24720780
Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51:224–32.
pubmed: 21936146
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
pubmed: 1360123
pmcid: 1360123
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161:584–91.
pubmed: 28040257
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.
pubmed: 17981197
Polyzos SA, Margioris AN. Sarcopenic obesity. Hormones (Athens). 2018;17:321–31.
Jang M, Park HW, Huh J, Lee JH, Jeong YK, Nah YW, et al. Predictive value of sarcopenia and visceral obesity for postoperative pancreatic fistula after pancreaticoduodenectomy analyzed on clinically acquired CT and MRI. Eur Radiol. 2019;29:2417–25.
pubmed: 30406311
Lodewick TM, van Nijnatten TJ, van Dam RM, van Mierlo K, Dello SA, Neumann UP, et al. Are sarcopenia, obesity and sarcopenic obesity predictive of outcome in patients with colorectal liver metastases? HPB. 2015;17:438–46.
pubmed: 25512239
Yamashita M, Kamiya K, Matsunaga A, Kitamura T, Hamazaki N, Matsuzawa R, et al. Prognostic value of sarcopenic obesity estimated by computed tomography in patients with cardiovascular disease and undergoing surgery. J Cardiol. 2019;74:273–8.
pubmed: 30928108
Malietzis G, Johns N, Al-Hassi HO, Knight SC, Kennedy RH, Fearon KC, et al. Low muscularity and myosteatosis is related to the host systemic inflammatory response in patients undergoing surgery for colorectal cancer. Ann Surg. 2016;263:320–5.
pubmed: 25643288
Zhang Y, Wang JP, Wang XL, Tian H, Gao TT, Tang LM, et al. Computed tomography-quantified body composition predicts short-term outcomes after gastrectomy in gastric cancer. Curr Oncol. 2018;25:e411–22.
pubmed: 30464692
pmcid: 6209549
Okumura S, Kaido T, Hamaguchi Y, Kobayashi A, Shirai H, Yao S, et al. Visceral adiposity and sarcopenic visceral obesity are associated with poor prognosis after resection of pancreatic cancer. Ann Surg Oncol. 2017;24:3732–40.
pubmed: 28871520
Cakir H, Heus C, van der Ploeg TJ, Houdijk AP. Visceral obesity determined by CT scan and outcomes after colorectal surgery; a systematic review and meta-analysis. Int J Colorectal Dis. 2015;30:875–82.
pubmed: 25772271
Okada K, Nishigori T, Obama K, Tsunoda S, Hida K, Hisamori S, et al. The incidence of postoperative complications after gastrectomy increases in proportion to the amount of preoperative visceral fat. J Oncol. 2019;2019:8404383.
pubmed: 31929799
pmcid: 6942899
Tappouni R, Mathew P, Connelly TM, Luke F, Messaris E. Measurement of visceral fat on preoperative computed tomography predicts complications after sigmoid colectomy for diverticular disease. Am J Surg. 2015;210:285–90.
pubmed: 25840842
Sandini M, Bernasconi DP, Fior D, Molinelli M, Ippolito D, Nespoli L, et al. A high visceral adipose tissue-to-skeletal muscle ratio as a determinant of major complications after pancreatoduodenectomy for cancer. Nutrition. 2016;32:1231–7.
pubmed: 27261062
Nakajima H, Yokoyama Y, Inoue T, Nagaya M, Mizuno Y, Kadono I, et al. Clinical benefit of preoperative exercise and nutritional therapy for patients undergoing hepato-pancreato-biliary surgeries for malignancy. Ann Surg Oncol. 2019;26:264–72.
pubmed: 30367303
Nakajima H, Yokoyama Y, Inoue T, Nagaya M, Mizuno Y, Kayamoto A, et al. How many steps per day are necessary to prevent postoperative complications following hepato-pancreato-biliary surgeries for malignancy? Ann Surg Oncol. 2020;27:1387–97.
pubmed: 31974713