Body Surface Area: A new predictive factor of mortality and pancreatic fistula after pancreaticoduodenectomy: A cohort-study

Introduction: To assess the role of Body Surface Area (BSA) in predicting pancreatic fistula and mortality after pancreaticoduodenectomy.

Methods: The data of patients who underwent pancreaticoduodenectomy between January 1992 to December 2012 at the University Hospital of Caen were collected prospectively and analyzed retrospectively. Pancreatic fistula was determined according to the ISPGF (International Study Group for Pancreatic Fistula) criteria. The Clavien and Dindo classification was used for grading post-operative complications and BSA was calculated according to the Boyd formula. Patients were classified as "large" and "non-large" using a BSA value ≥1.82 to define the large group and the non-large group. The primary end points were post-operative mortality rate, and the rate and grade of post-operative pancreatic fistula.

Results: 411 patients underwent pancreaticoduodenectomy with a mean age of 61.2 (±12.1) year. Six patients (1.45%) died post-operatively. Patients with a BSA ≥1.82 had a significantly higher risk of post-operative death: OR 3.55 [1.43-8.80] (p < 0.0005). Eighty-five patients (20.7%) developed a post-operative pancreatic fistulas. The grade A pancreatic fistula rate was 87.1%. Patients with a BSA ≥1.82 had a significantly higher risk of developing overall post-operative pancreatic fistula (p < 0.038). Multivariate analysis showed that "large" patients (1.86, 95%CI[1.09-3.92], p = 0.0229), soft pancreas (6.5, 95%CI[2.39-9.31], p = 0.0155) and a BMI ≥ 25 (1.09, 95%CI[1.031-1.163], p = 0.0407) were independent risk factors of pancreatic fistula.

Conclusion: Body Surface Area is a useful factor after pancreaticoduodenectomy to predict mortality and post-operative fistula.