Body Composition and Treatment Resilience After Pancreaticoduodenectomy

Pancreaticoduodenectomy remains a cornerstone of curative-intent treatment for periampullary malignancies. Postoperative recovery, receipt of adjuvant therapy, and long-term outcomes vary even among patients with comparable tumor stage and surgical care. Host-related factors, including body composition, may contribute to this variability. Body mass index does not distinguish skeletal muscle from adipose tissue, whereas computed tomography (CT)-derived muscle area and attenuation provide separate measures of muscle quantity and quality. In this review, treatment resilience denotes the capacity to progress through surgery and planned postoperative or adjuvant care without clinically consequential interruption. Reported indicators include postoperative complications and recovery, time to adjuvant treatment, grade 3 or higher toxicity, dose reduction or delay, early discontinuation, and treatment completion; thresholds vary among studies. Retrospective studies associate adverse muscle phenotypes with some of these outcomes, but results are heterogeneous and do not establish causality. Associations with survival also vary by measurement method, tumor type, and treatment delivery. This narrative review summarizes CT-based assessment, perioperative and treatment-delivery outcomes, tumor-specific considerations, and the limited evidence for prehabilitation and nutritional interventions. Body-composition measures may complement established clinical and pathological factors, but prospective validation and standardized methods are required before they can direct treatment.