The Effect Of CT Quantitative Visceral Adipose Tissue On Postoperative Complications Of Pancreatic Head Cancer

Objective:To investigate the effect of CT quantitative visceral adipose tissue(VAT)on postoperative complications in patients with pancreatic head cancer undergoing pancreaticoduodenectomy.Methods:The clinical and imaging data of 113 patients who underwent pancreaticoduodenectomy for pancreatic head cancer at the First Hospital of Lanzhou University from November 2016 to December 2022 were retrospectively analyzed.The areas of VAT and subcutaneous adipose tissue(SAT)were delineated and calculated by semi-automatic software.According to VAT≥100 cm~2,all patients were divided into high VAT group(VAT-H group,39 cases)and low VAT group(VAT-L group,74 cases).According to BMI≥24 kg/m~2,the patients were divided into BMI-H group(n=29)and BMI-L group(n=84).The clinical data and postoperative complications were compared between VAT-H group and VAT-L group,and between BMI-H group and BMI-L group.In addition,according to gender grouping,the difference of abdominal fat distribution between male and female patients was compared,and Pearson correlation analysis was used to test the correlation between BMI and VAT and SAT.Finally,univariate and multivariate Logistic regression models were used to analyze the risk factors of postoperative complications in patients with pancreatic head cancer after pancreaticoduodenectomy.Results:1.Comparison of clinical characteristic between different groups.There were no significant differences in gender,hypertension,platelet/lymphocyte ratio(PLR),albumin(ALB),high-density lipoprotein(HDL),abnormal CA199,operation method,operation duration,postoperative hospital stay,TNM stage,T stage,N stage and tumor differentiation between VAT-H group and VAT-L group(all P>0.05).Compared with the VAT-L group,VAT-H group had higher age,incidence of diabetes,neutrophil/lymphocyte ratio(NLR),total cholesterol(TC),triglyceride(TG),low-density lipoprotein(LDL),SAT,operation cost,and lower lymphocyte/monocyte ratio(LMR)and lymph node metastasis,The differences were statistically significant(all P<0.05).Compared with the BMI-L group,the BMI-H group also had higher SAT,and the difference was statistically significant(P<0.05),and the other indicators were not statistically significant(all P>0.05).2.Comparison of incidence of postoperative complications between different groups.Pancreatic fistula occurred in 12 patients(10.6%)and intra-abdominal infection in 16 patients(14.2%).The incidence of pancreatic fistula in the VAT-H group was significantly higher than that in the VAT-L group(20.5%vs 5.4%,P=0.022),while there was no significant difference in abdominal infection between the VAT-H group and the VAT-L group(P>0.05);There was no significant difference in the incidence of pancreatic fistula and intra-abdominal infection between the BMI-H group and the BMI-L group(both P>0.05).3.Characteristics of abdominal fat distribution in different genders.SAT and total adipose tissue(TAT)in female patients were significantly higher than those in male patients(P<0.05);The visceral adipose tissue/subcutaneous adipose tissue ratio(VSR)of male patients was significantly higher than that of female patients(P<0.05);There was no significant difference in VAT between males and females(P>0.05).4.Correlation analysis of BMI with VAT and SAT.The results showed that BMI value was significantly associated with VAT(r=0.588,P<0.001),SAT(r=0.658,P<0.001).In particular,the correlation with SAT was higher.5.Risk factors for postoperative complications were analyzed.Multivariate Logistic regression analysis showed that VAT≥100cm~2(OR=7.511,95%CI=1.796-31.415,P=0.006)and moderately well differentiated tumor(OR=6.377,95%CI=1.572-25.869,P=0.010)were independent risk factors for pancreatic fistula after pancreaticoduodenectomy for pancreatic head cancer.Conclusions:1.Visceral obesity(VAT≥100cm~2)may be an important predictor of postoperative pancreatic fistula in patients with pancreatic head cancer after pancreaticoduodenectomy.2.Visceral obesity(VAT≥100cm~2)in patients with pancreatic head cancer is associated with higher age,incidence of diabetes,systemic inflammation(higher NLR and lower LMR)and lipid metabolism(TC,TG and LDL)levels.