Impact of preoperative skeletal muscle mass on the healing time of postoperative pancreatic fistula after pancreaticoduodenectomy

BACKGROUND: Postoperative pancreatic fistula (POPF) is a serious complication following pancreaticoduodenectomy (PD). While numerous studies have investigated POPF incidence and risk factors, few have focused on POPF healing time (POPF-HT). Skeletal muscle mass has been increasingly recognized as an endocrine organ involved in interorgan communication. The aim of this study was to evaluate how skeletal muscle mass influenced the healing time of POPF after PD. METHODS: This investigation included patients who developed POPF of grade B-C after PD with pancreaticojejunostomy during the study period. POPF-HT was defined as the duration from the date of PD to the removal of all drains placed for POPF treatment. Skeletal muscle mass was assessed based on preoperative computed tomography images. Clinical factors associated with POPF-HT were analyzed, including skeletal muscle index (SMI). RESULTS: The mean POPF-HT was 40 ± 15 days (median: 37 days; range: 21-105 days). Compared to those with high SMI, patients with low SMI had a significantly longer POPF-HT (46 ± 18 days vs. 37 ± 11 days, p = 0.0101). In univariate analysis, low SMI was significantly associated with prolonged POPF-HT (hazard ratio: 0.5655, 95% confidence interval: 0.3687-0.8673, p = 0.0090). Kaplan-Meier curves confirmed that patients with low SMI exhibited significantly delayed cumulative POPF healing (p = 0.0065). CONCLUSION: Decreased skeletal muscle mass is significantly associated with prolonged POPF-HT after PD. Therefore, preoperative SMI may serve as a potentially modifiable factor associated with POPF-HT.