Purpose: Pancreaticoduodenectomy (PD) is the mainstay of surgical treatment for localized pancreatic and periampullary malignancy. Post-operative morbidity affects up to 65% of patients. Delayed gastric emptying (DGE) is one of the leading causes of post-operative morbidity. Sarcopenia (decreased muscle mass) has been associated with increased complications after PD. The aim of this study was to correlate between preoperative sarcopenia and the incidence of DGE following PD for tumors of the pancreas by measuring the psoas muscle area on CT scans. This may help to identify patients at risk for DGE and potentially avoid this complication.
Materials and Methods: A prospective study including all patients who underwent elective PD for pancreatic or periampullary malignancy at Shaare Zedek Medical Centre between 12/2014 - 3/2017. Pre-operative, intra-operative and post-operative demographic, clinical and pathological related variables were collected. Patients were included in the study if a CT scan was performed and available less than 30 days preoperatively. The images were analyzed using a free-hand circumferential region of interest (ROI) of the borders of the psoas muscles in the axial plane, at the level of the superior aspect of L4. Area (mm2) was calculated for the psoas muscles on both sides. Sarcopenia was defined as an average area of 910 mm2. An average value was used in the final analysis. Sarcopenia was defined as an average measurement in the lower one third of the cohort.
Results: Of the 57 patients included in the study (30 males, average age 72) 12 (21.1%) had DGE. 17 patients were defined as sarcopenic (13 females, 4 males). Of them, 7 had DGE (41.2%). 70% of patients with DGE had sarcopenia vs. 30% in the non-DGE group (70 vs 30%, p = 0.007). There was no significant difference in the gender, age, pre-operative body mass index or albumin.
Conclusion: Based on the assumption that a measured psoas muscle area correlates with the total body muscle mass, CT is becoming an effective tool for assessment of sarcopenia. As a result, the additional data that can be extracted from the CT scans is becoming a common practice. The female preponderance in the sarcopenic group may indicates the need for creating different cut-offs for males and females. In our study, sarcopenia was a first possible indicator of subsequent DGE after PD. In post PD patients, the ability to predict DGE allows tailored patient counselling and postoperative care. However, further research in this field is needed.
