258 A Systematic Review and Meta-Analysis on the Effect of Body Mass Index (BMI) on Pancreaticoduodenectomy Outcomes

Abstract Aim To conduct a systematic review and meta-analysis to evaluate the impact of obesity on postoperative outcomes in patients undergoing Pancreaticoduodenectomy. The objective is to compare key morbidity and mortality outcomes between obese and non-obese cohorts to determine the safety profile of this procedure in the obese population. Method We conducted a systematic search of electronic information sources, including MEDLINE, EMBASE, CINAHL, CENTRAL, ClinicalTrials.gov, and bibliographic reference lists. We applied a combination of free text search and controlled vocabulary search adapted to thesaurus headings, search operators, and limits in each of the above-mentioned databases. Primary outcome parameters included mortality, severe complications, postoperative pancreatic fistula (POPF), surgical site infections (SSI), delayed gastric emptying, and reoperation rates. Results We identified 13 studies for inclusion. The analysis revealed that the obese group had significantly longer operative times (Mean Difference: 24.16 min, P=0.02) and higher estimated blood loss (Mean Difference: 153.23 mL, P < 0.0001). The risk of developing POPF (OR: 1.86, P=0.0009), superficial SSI (OR: 1.21, P=0.0004), organ space SSI (OR: 1.49, P < 0.00001), and the need for reoperation (OR: 1.20, P=0.005) were all significantly higher in the obese group. There was no statistically significant difference between the two cohorts for mortality (P=0.11) or severe complications (P=0.40). Conclusions This meta-analysis suggests that obesity is associated with worse intraoperative outcomes and a higher risk of specific postoperative complications such as pancreatic fistula and surgical site infections following Pancreaticoduodenectomy. However, these factors do not translate into a significantly higher risk of overall mortality.