Consequences of Metabolic Syndrome on Postoperative Outcomes After Pancreaticoduodenectomy

World J Gastroenterol. 2017 May 7;23(17):3142-3149. doi: 10.3748/wjg.v23.i17.3142.

Abstract

Aim: To analyze immediate postoperative outcomes after pancreaticoduodenectomy regarding metabolic syndrome.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Metabolic syndrome; Pancreaticoduodenectomy; Postoperative outcomes; Soft pancreas.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Female
  • Hospital Mortality
  • Humans
  • Incidence
  • Male
  • Metabolic Syndrome / complications*
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / surgery
  • Middle Aged
  • Pancreas / surgery
  • Pancreatic Ducts / anatomy & histology
  • Pancreatic Fistula / epidemiology*
  • Pancreatic Fistula / etiology
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy / adverse effects*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Period
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome