Rugved V Kulkarni, Savio George Barreto, Surya P Rao, Shailesh V Shrikhande
Background Obesity is assuming world-wide epidemic proportions and is an independent risk factor for pancreatic cancer and surgical morbidity in general. It is essential to determine if obesity influences perioperative pancreatic surgical outcomes. Methods A thorough literature search was conducted using PubMed, Medline, Cochrane and Embase databases, using the search terms “pancreatic surgery”, “pancreatoduodenectomy”, “pancreaticoduodenectomy”, “obesity”, “body mass index”, “body mass index”, “surgical outcome”, “postoperative complications”, “complications” from January 1990 to June 2013 without restrictions. All publications from past 23 years were considered for review. Results Of the 598 articles retrieved, 22 studies were identified describing impact of obesity on perioperative outcomes following pancreatoduodenectomy. Obese individuals (with body mass index≥25) are at 2.2 times (relative risk=2.169; confidence interval=1.572-2.994) more risk for developing post-operative pancreatic fistula compared to non-obese individuals. Obese individuals had more wound infections (relative risk =1.69; confidence interval=1.225-2.274). 10 of 22 studies reported a significant increase in blood loss with increasing body mass index/visceral fat area. No evidence to suggest impact of obesity on other parameters was noted. Conclusions Obesity increases the risk of post-operative pancreatic fistula and wound infections but not operating time or development of delayed gastric emptying, post-pancreatectomy haemorrhage and intra-abdominal collections. Obesity contributes to an increase in intra-operative blood loss.
