O053 - MYOSTEATOSIS PREDICTS MAJOR COMPLICATIONS AFTER PANCREATIC SURGERY IN CHRONIC PANCREATITIS: A RETROSPECTIVE POOLED ANALYSIS OF THE ESCAPE AND PORSCH COHORTS.

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O053

MYOSTEATOSIS PREDICTS MAJOR COMPLICATIONS AFTER PANCREATIC SURGERY IN CHRONIC PANCREATITIS: A RETROSPECTIVE POOLED ANALYSIS OF THE ESCAPE AND PORSCH COHORTS.

L. W. A. J. Vanderbroeck1,2,3,*, A. Nagelhout3,4, N. D. Hildenbrand1,2,5, Y. Issa6, J. F. Smits7,8, A. C. Henry7,9, D. P. van Dijk1,2, R. Brecheisen1, Q. I. Molenaar7, H. C. van santvoort7, M. A. Boermeester10,11, M. G. Besselink10,11, S. S. Rensen1, S. W. Olde Damink1,2,5,12, S. A. Bouwense1,2 on behalf of Dutch Pancreatitis Study Group & Dutch Pancreatic Cancer Group

1Institute for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 2Department of Surgery, Maastricht University Medical Centre, Maastricht, 3Department of Research & Development, St. Antonius Hospital, Nieuwegein, 4Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands, 5Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany, 6Department of Surgery, Leiden University Medical Center, Leiden, 7Regional Academic Cancer Center Utrecht (RAKU), St. Antonius Hospital, Nieuwegein, 8Department of Surgery, Diakonessenhuis, Utrecht, 9Department of Surgery, St. Antonius Hospital, Nieuwegein, 10Cancer Center Amsterdam, 11Department of Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands, 12Bridge Institute of Experimental Tumor Therapy (BIT), Division of Solid Tumor Translational Oncology (DKTK), West German Cancer Center, University of Duisburg-Essen, Essen, Germany

 

Rationale: Chronic pancreatitis (CP) leads to systemic metabolic impairment resulting in chronic wasting that may affect surgical outcomes. Body composition parameters may reflect chronic wasting and could serve as a tool for preoperative risk stratification in patients undergoing pancreatic surgery. 

Methods: We performed a retrospective pooled analysis of two prospective Dutch multicenter cohorts. Patients undergoing pancreatic surgery for CP with available preoperative computed tomography imaging were included (n=117). Skeletal muscle radiation attenuation (SM-RA), index and adipose tissue indices were quantified at the 3rd lumbar vertebra using Mosamatic automated segmentation. Cut-off values to assess myosteatosis were determined using the Youden-index. Sex-specific z-scores were used to assess continuous relationships. Primary outcome was major complications (defined as Clavien–Dindo ≥IIIa). Multivariable logistic regression analyses were performed.

Results: Major complications occurred in 28% of participants. Myosteatosis was defined as SM-RA below 44.5 Hounsfield Units (HU) for males and 40.0 HU for females. In multivariable analysis, myosteatosis (aOR 4.04, 1.14–14.39; p=0.03) and age (aOR 1.05, 1.01–1.10; p=0.02) remained independently associated with major complications. The combination of myosteatosis and systemic inflammation markedly increased risk (aOR 7.21, 1.26–41.35; p=0.03). Analysis using z-scores showed a risk reduction of ±48% per standard deviation increase in SM-RA (aOr 0.521, 0.283 – 0.916; p=0.028).

Conclusion: Myosteatosis is associated with major postoperative complications after pancreatic surgery for CP. The combination of preoperative myosteatosis and inflammation is more predictive of major complications, supporting the inclusion of these host factors as clinically relevant biomarkers for perioperative risk stratification.

Disclosure of Interest: None declared