E4873. CT-Assessment of Sarcopenia and Adipopenia as a Predictor of Complications After Whipple Surgery
  1. Anurima Patra; Tata Medical Center
  2. Saugata Sen; Tata Medical Center
This study aims to evaluate the value of CT-derived body composition indices as a predictive marker of perioperative outcomes after Whipple surgery.

Materials and Methods:
This was a retrospective study of 155 patients (97 men:58 women, mean [range)] age: 55 [19–79] y) who underwent pancreaticoduodenectomy in 2018–2020 for pancreas head adenocarcinoma (n = 55), periampullary carcinoma (n = 100), and distal cholangiocarcinoma (n = 4). Skeletal muscle index (SMI; cross-section area of psoas muscle divided by patient height) and visceral-to-subcutaneous adipose tissue area ratio (VSR) were measured on preoperative contrast-enhanced CT (CECT) using core slicer. Muscle and adipose tissue areas were calculated at L3 vertebrae level on axial CT using Hounsfield thresholds of –30 to +150 HU for psoas muscle, –150 to –50 for visceral adipose tissue, and –190 to –30 for subcutaneous adipose tissue. SMI (cm²/m²) and VSR thresholds were defined as values lower than the lowest quartile (54.8 for men, 36.2 for women), and values higher than the highest quartile (0.66 for men, 0.45 for women), respectively. Findings were correlated with postoperative complications (within 30 days of surgery), duration of hospital stay, duration of surgery, and intraoperative blood loss. Surgical complications were graded for severity using Clavien-Dindo classification.

Mean (range) time interval between preoperative CT and surgery was 27 (30–10) days. Mean hospital stay duration was 18 (6–73) days. One or more major postoperative complications were seen in 84 (36%) patients; 38155 (28%) patients showed sarcopenia with mean SMI of 40 cm²/m² (men) and 37 cm²/m² (women). There were 131/155 (84%) patients who showed adipopenia with mean VSR of 1.2 cm²/m² (men) and 0.7 cm²/m² (women). There was no significant correlation between low SMI and high VSR with rates of postsurgical complications. Patients with high VSR had longer duration of surgery and increased intraoperative blood loss (p < 0.05).

No correlation was found between sarcopenia (low SMI) and adipopenia (high VSR) with postoperative complications, except for significantly higher blood loss and longer surgical time in patients with adipopenia. Preoperative visceral fat estimation might serve as a predictive marker of intraoperative complications with potential implications for patient stratification and clinical decision making.