Visceral adipose tissue is a better predictor than BMI in the alternative Fistula Risk Score in patients undergoing pancreatoduodenectomy

Lucassen, C.J.; Groen, J.V.; Aziz, M.H.; Bastiaannet, E.; Bonsing, B.A.; Leistra, E.; ... ; Mieog, J.S.D. (2022)

Article / Letter to editor

Background: Muscle attenuation (MA) and visceral adipose tissue (VAT) have not yet been included in the currently used alternative Fistula Risk Score (a-FRS). The aim of this study was to examine the added value of these parameters as predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) in the a-FRS after pancreatoduodenectomy compared to Body Mass Index (BMI). Methods: A single center retrospective cohort study was performed in patients who underwent pancreatoduodenectomy between 2009 and 2018. The a-FRS model was reproduced, MA and VAT were both combined and separately added to the model instead of BMI using logistic regression analysis. Model discrimination was assessed by ROC-curves. Results: In total, 329 patients were included of which 55 (16.7%) developed CR-POPF. The a-FRS model showed an AUC of 0.74 (95%CI: 0.68-0.80). In this model, BMI was not significantly associated with CR-POPF (p = 0.16). The MA + VAT model showed an AUC of 0.81 (95%CI: 0.75-0.86). VAT was significantly associated with CR-POPF (per cm2, OR: 1.01; 95%CI: 1.00-1.01; p < 0.001). The AUC of the MA + VAT model differed significantly from the AUC of the a-FRS model (p = 0.001). Conclusion: Visceral adipose tissue is of added value in the a-FRS compared to BMI in predicting CRPOPF in patients undergoing pancreatoduodenectomy.

• All authors: Lucassen, C.J.; Groen, J.V.; Aziz, M.H.; Bastiaannet, E.; Bonsing, B.A.; Leistra, E.; Feshtali, S.S.; Vahrmeijer, A.L.; Droop, A.; Mieog, J.S.D.
• Date: 2022-10-18
• Journal: HPB
• Volume: 24
• Issue: 10
• Pages: 1679 - 1687
• DOI: doi:10.1016/j.hpb.2022.03.004
• Link: https://www.sciencedirect.com/science/article/pii/S1365182X22000788?via%...