Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Consequences of metabolic syndrome on postoperative outcomes after pancreaticoduodenectomy
Alban Zarzavadjian Le Bian, David Fuks, Sophie Chopinet, Sébastien Gaujoux, Manuela Cesaretti, Renato Costi, Ajay P Belgaumkar, Claude Smadja, Brice Gayet
Alban Zarzavadjian Le Bian, Manuela Cesaretti, Renato Costi, Department of Digestive Surgery, Centre Hospitalier Simone Veil, 95600 Eaubonne, France
Alban Zarzavadjian Le Bian, Laboratory of Medical Ethics and Legal Medicine, University Paris Descartes, 75006 Paris, France
David Fuks, Sophie Chopinet, Ajay P Belgaumkar, Brice Gayet, Department of Digestive disease - Institut Mutualiste Montsouris, 75014 Paris, France
David Fuks, Sébastien Gaujoux, Université Paris Descartes, 75006 Paris, France
Sébastien Gaujoux, Department of Digestive Surgery, Assistance Publique, Hôpitaux de Paris Hôpital Cochin, 75014 Paris, France
Claude Smadja, Department of Digestive Surgery, Assistance Publique, Hôpitaux de Paris Hôpital Antoine Béclère, 157 rue de la Porte Trivaux Boulevard Général Leclerc, 92140 Clamart, France
Author contributions: Zarzavadjian Le Bian A, Fuks D, Smadja C and Gayet B provide the conception of the work; Zarzavadjian Le Bian A, Fuks D, Smadja C, Cesaretti M and Belgaumkar AP contributed to acquisition, analysis, interpretation of data; Zarzavadjian Le Bian A, Fuks D, Chopinet S, Gaujoux S, Costi R, and Gayet B contributed to draft the work or revising it critically for important intellectual content; Zarzavadjian Le Bian A, Fuks D, Cesaretti M, Costi R, Belgaumkar AP, Smadja C and Gayet B final approval.
Institutional review board statement: The study was reviewed and approved by the “Groupe de Réflexion Ethique”, Centre Hospitalier Simone Veil, Eaubonne, France.
Conflict-of-interest statement: All authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: 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/
Correspondence to: Dr. Alban Zarzavadjian Le Bian, Department of Digestive Surgery, Centre Hospitalier Simone Veil, 14, rue des Saint Prix, 95600 Eaubonne, France. spleen2008@live.fr
Telephone: +33-6-85109112
Received: January 13, 2017
Peer-review started: January 14, 2017
First decision: February 23, 2017
Revised: March 3, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: May 7, 2017
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.
Core tip: As metabolic syndrome is related to fatty pancreas and fatty pancreas is related to pancreatic fistula, postoperative morbi-mortality should theoretically increase in patient with metabolic syndrome and undergoing pancreaticoduodenectomy. In two academic centers, postoperative outcomes of 270 consecutive patients undergoing pancreaticoduodenectomy were retrospectively compared in regards of metabolic syndrome. 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. The present series suggests that metabolic syndrome does not jeopardize postoperative outcomes after pancreaticoduodenectomy.
