European Radiology

, Volume 29, Issue 5, pp 2417–2425 | Cite as

Predictive value of sarcopenia and visceral obesity for postoperative pancreatic fistula after pancreaticoduodenectomy analyzed on clinically acquired CT and MRI

  • Minji Jang
  • Hyung Woo Park
  • Jimi HuhEmail author
  • Jong Hwa Lee
  • Yoong Ki Jeong
  • Yang Won Nah
  • Jisuk Park
  • Kyung Won Kim



To evaluate predictive values of sarcopenia and visceral obesity measured from preoperative CT/MRIs for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy in patients with periampullary malignancies.


From the prospectively constructed surgical registry, we included adult patients treated with pancreaticoduodenectomy. Based on CT/MRIs, body morphometric analysis was performed to evaluate the visceral obesity and sarcopenia, based on the areas of visceral fat and skeletal muscle measured at the L3 vertebrae level. We retrieved various perioperative factors from registry. As outcomes of postoperative complications, we evaluated POPF and major complications based on the Clavien-Dindo classification. Multivariate logistic regression analyses were performed.


From a total of 284 patients (163 males, 121 females) who met the inclusion/exclusion criteria, POPF, major complications, and 60-day mortality occurred in 52 (18.3%), 34 (12.0%), and 6 (2.1%), respectively. Sarcopenia and visceral obesity were noted in 123 (75.5%) and 66 (40.5%) of men and 68 (56.2%) and 53 (43.8%) of women, respectively. Combination of sarcopenia and obesity (sarcopenic obesity) was noted in 31.9% (52/163) of men and in 26.4% (32/121) of women. In multivariate logistic regression analyses, sarcopenic obesity was the only independent predictor for POPF (OR 2.65, 95% CI 1.43–4.93), and the vascular resection during pancreaticoduodenectomy was the only independent predictor for severe complications (OR 3.75, 95% CI 1.61–8.70).


Sarcopenic obesity might be highly predictive for POPF. Body morphometric analysis in preoperative CT/MRI combined with assessment of perioperative clinical features may help to identify high-risk patients and determine perioperative management strategies.

Key Points

• Sarcopenic obesity might be predictive for postoperative pancreatic fistula after pancreaticoduodenectomy.

• The vascular resection during pancreaticoduodenectomy might be predictive of major complications.

• Body morphometric analysis might be helpful for identifying high-risk patients.


Muscle weakness Sarcopenia Pancreaticoduodenectomy Postoperative complications Treatment outcome 



American Society of Anesthesiologists


Bioelectrical impedance analysis


Body mass index


Computed tomography


Dual energy x-ray absorptiometry


European working group on sarcopenia in older people


Hounsfield unit


International Study Group on Pancreatic Fistula


Main pancreatic duct


Magnetic resonance cholangiopancreatography


Picture archiving and communication system


Postoperative pancreatic fistula


Subcutaneous fat area


Signal intensity


Total abdominal muscle area


Visceral fat area



This research was supported by a grant from Guerbet (No. GK-XTX-2017-34) and a grant (No. HI18C1216) from the Korea Health Industry Development Institute (KHIDI).

Compliance with ethical standards


The scientific guarantor of this publication is Jimi Huh.

Conflict of interest

J.H. is a recipient of the grant from Guerbet.

K.W.K. is a recipient of the grant from the Korea Health Industry Development Institute (KHIDI).

The other authors have no conflict of interest.

Statistics and biometry

One author (Kyung Won Kim) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Diagnostic or prognostic study

• Performed at one institution

Supplementary material

330_2018_5790_MOESM1_ESM.docx (117 kb)
ESM 1 (DOCX 116 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Minji Jang
    • 1
  • Hyung Woo Park
    • 2
  • Jimi Huh
    • 1
    • 3
    Email author
  • Jong Hwa Lee
    • 1
  • Yoong Ki Jeong
    • 1
  • Yang Won Nah
    • 2
  • Jisuk Park
    • 4
  • Kyung Won Kim
    • 4
  1. 1.Department of RadiologyUniversity of Ulsan College of Medicine, Ulsan University HospitalUlsanSouth Korea
  2. 2.Department of SurgeryUniversity of Ulsan College of Medicine, Ulsan University HospitalUlsanSouth Korea
  3. 3.Department of RadiologyAjou University School of Medicine & Graduate School of Medicine, Ajou University Medical CenterSuwonSouth Korea
  4. 4.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea

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