Prevalence of sarcopenia in patients with pancreatic and periampullary malignancies undergoing pancreaticoduodenectomy: a prospective pilot study

Sarcopenia is common in pancreatic and periampullary malignancies and may be associated with adverse outcomes after pancreaticoduodenectomy. Data from Indian patients are limited. This prospective pilot study estimated the prevalence of sarcopenia using a multidimensional assessment of muscle mass, strength, and physical performance. Adults aged 18–75 years undergoing pancreaticoduodenectomy for pancreatic or periampullary malignancy between December 2019 and July 2021 were prospectively assessed. Muscle mass was estimated by psoas muscle index (PMI) on computed tomography, muscle strength by handgrip dynamometry, and physical performance by 6-m gait speed. Because validated Indian sarcopenia-specific cut-offs were unavailable, age- and sex-specific thresholds from published studies were used. Patients with low muscle mass plus low strength and/or low physical performance were classified as having sarcopenia; those with all three abnormalities were classified as having severe sarcopenia. “Low muscle mass only” was used descriptively and not as an EWGSOP2 diagnostic category. Fifty patients were included (mean age 60.2 ± 9.4 years; 28 men). Low PMI, low handgrip strength, and low gait speed were present in 72%, 60%, and 42%, respectively. Thirty-three patients (66%) met the study definition of sarcopenia, including 16 (32%) with severe sarcopenia. ECOG performance status 2–3 was strongly associated with sarcopenia (72.7% vs. 5.9%; p < 0.001). Sarcopenic patients had longer intensive-care-unit stay (6.15 ± 4.25 vs. 2.41 ± 1.37 days; p < 0.001) and postoperative hospital stay (16.63 ± 10.42 vs. 11.23 ± 3.26 days; p = 0.006). Diabetes was more frequent in the non-sarcopenic group (76.5% vs. 39.4%; p = 0.01); this unexpected association should be interpreted cautiously because of the small sample and absence of multivariable adjustment. Sarcopenia was common in this small, single-centre Indian cohort. Poorer ECOG performance status was associated with sarcopenia, but causality and independence of this association cannot be inferred. The prevalence estimate is sensitive to the selected thresholds and requires confirmation using validated Indian cut-offs and larger multicentre cohorts.