PP161 - A COMBINED PREOPERATIVE CARDIORESPIRATORY FITNESS AND BODY COMPOSITION PHENOTYPE PREDICTS MAJOR COMPLICATIONS AFTER PANCREATODUODENECTOMY, INDEPENDENT OF POSTOPERATIVE PANCREATIC FISTULA RISK

PP161

A COMBINED PREOPERATIVE CARDIORESPIRATORY FITNESS AND BODY COMPOSITION PHENOTYPE PREDICTS MAJOR COMPLICATIONS AFTER PANCREATODUODENECTOMY, INDEPENDENT OF POSTOPERATIVE PANCREATIC FISTULA RISK

N. D. Hildebrand^1,2,3,*, Z. M. Alhulaili⁴, H. Driessens⁴, L. S. Hoeijmakers², B. C. Bongers², D. P. van Dijk², S. S. Rensen², M. den Dulk^2,3, J. M. Klaase⁴, S. W. Olde Damink^1,2,3

¹Department of General-, Visceral-, Vascular-, and Transplantation Surgery, University Medicine Essen, Essen, Germany, ²Department of Surgery, Maastricht University, ³Department of Surgery, Maastricht University Medical Center+, Maastricht, ⁴University Medical Center Groningen, Groningen, Netherlands

Rationale: Major complication rates after pancreatoduodenectomy (PD) are high. Cardiorespiratory fitness (CRF) and body composition (BC) are predictive of postoperative outcomes. This study evaluated the association between preoperative assessment of CRF and BC and major complications following PD. 

Methods: In this two-center retrospective cohort study (2022-24), patients undergoing PD were included. Preoperative CRF was assessed using cardiopulmonary exercise testing (CPET) or modified steep ramp test (mSRT). Poor CRF was defined as oxygen uptake (VO₂) at the ventilatory anaerobic threshold <11.0mL/kg/min or VO₂ at peak <18.0mL/kg/min during CPET, or work rate at peak <2.1W/kg (mSRT). BC parameters were derived at L3 level. Low muscle mass based on skeletal muscle index (SMI) and myosteatosis (defined as low skeletal muscle radiation attenuation, SM-RA) were assessed. Primary outcome was major complications (Clavien-Dindo ≥III). 

Results: Among 175 patients (mean age 69.1 years, 45% female), 35% were unfit; 55% had low muscle mass, 35% had myosteatosis. Major complications occurred in 38%. 8% required unplanned intensive care unit (ICU) admission. Preoperative cardiorespiratory fitness correlated moderately with SM-RA (ρ=0.36-0.47; p<0.01).  Poor CRF predicted major complications in multivariable analysis (aOR 2.54, p=0.02). Combined myosteatosis and poor CRF (n=28, 16.0%) predicted major complications (aOR 3.40, p=0.02) and unplanned ICU admission (aOR 4.62, p=0.04). 

Conclusion: Myosteatosis correlates with lower cardiorespiratory fitness. The combination of preoperative myosteatosis and poor cardiorespiratory fitness is associated with major complications and postoperative ICU admission. These patient phenotypes may help to refine personalized risk assessment, guide targeted preventive interventions in the future.

Disclosure of Interest: None declared