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Introduction <p>Postoperative pancreatic fistula (POPF) remains one of the most significant causes of morbidity following pancreatoduodenectomy (PD). The Alternative Fistula Risk Score (a-FRS) incorporates body mass index (BMI) as a surrogate measure of adiposity. Nevertheless, BMI frequently inadequately captures the “thin-fat” phenotype prevalent in Asian populations, wherein individuals may display significant visceral adiposity despite possessing a normal or low BMI. This study aimed to evaluate whether visceral adipose tissue (VAT) is superior to BMI in predicting clinically relevant postoperative pancreatic fistula (CR-POPF) in an Indian patient cohort.</p> Methods <p>This prospective observational study included 48 patients undergoing pancreatoduodenectomy at a tertiary care center. Preoperative VAT area (cm<sup>2</sup>) was quantified at the level of the L3 vertebra using semi-automated CT analysis software (Syngo.via). The primary outcome was the development of CR-POPF as defined by the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria. The diagnostic performance of VAT and BMI was compared using receiver operating characteristic (ROC) curve analysis.</p> Results <p>The incidence of CR-POPF was 31.2% (n = 15). Patients who developed CR-POPF had significantly higher VAT values compared with those who did not (97.10 ± 40.66 cm<sup>2</sup> vs 47.70 ± 32.65 cm<sup>2</sup>; p &lt; 0.001). In contrast, BMI did not differ significantly between the groups (21.63 vs 19.87&#xa0;kg/m<sup>2</sup>; p = 0.173). ROC analysis indicated that VAT exhibited strong diagnostic performance (AUROC 0.826; p &lt; 0.001), while BMI demonstrated limited predictive ability (AUROC 0.612; p = 0.221). A VAT cutoff of ≥ 65.9 cm<sup>2</sup> predicted CR-POPF with a sensitivity of 86.7% and specificity of 72.7%.</p> Conclusion <p>Visceral adipose tissue is a superior predictor of clinically relevant postoperative pancreatic fistula compared with BMI in this Indian cohort. Traditional weight-based indices such as BMI may underestimate surgical risk in patients with occult visceral adiposity. Preoperative CT-based quantification of VAT may therefore provide a more precise method for identifying high-risk patients. Larger multicenter studies are warranted to validate these findings.</p>

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Evaluation of Visceral Adipose Tissue Versus Body Mass Index in Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy – A Prospective Observational Cohort Study

  • 期刊论文

  • 发表日期：

    2026年5月30日

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  • S Monisha,
  • Amit Gupta,
  • Udit Chauhan,
  • Lokesh Arora,
  • Karamveer Singh,
  • Mohd Ozair Khan,
  • Mareshwari S.K.S.,
  • Ammapalem Satish,
  • Arunkumar V.,
  • Vatsala Singh

摘要

Introduction

Postoperative pancreatic fistula (POPF) remains one of the most significant causes of morbidity following pancreatoduodenectomy (PD). The Alternative Fistula Risk Score (a-FRS) incorporates body mass index (BMI) as a surrogate measure of adiposity. Nevertheless, BMI frequently inadequately captures the “thin-fat” phenotype prevalent in Asian populations, wherein individuals may display significant visceral adiposity despite possessing a normal or low BMI. This study aimed to evaluate whether visceral adipose tissue (VAT) is superior to BMI in predicting clinically relevant postoperative pancreatic fistula (CR-POPF) in an Indian patient cohort.

Methods

This prospective observational study included 48 patients undergoing pancreatoduodenectomy at a tertiary care center. Preoperative VAT area (cm2) was quantified at the level of the L3 vertebra using semi-automated CT analysis software (Syngo.via). The primary outcome was the development of CR-POPF as defined by the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria. The diagnostic performance of VAT and BMI was compared using receiver operating characteristic (ROC) curve analysis.

Results

The incidence of CR-POPF was 31.2% (n = 15). Patients who developed CR-POPF had significantly higher VAT values compared with those who did not (97.10 ± 40.66 cm2 vs 47.70 ± 32.65 cm2; p < 0.001). In contrast, BMI did not differ significantly between the groups (21.63 vs 19.87 kg/m2; p = 0.173). ROC analysis indicated that VAT exhibited strong diagnostic performance (AUROC 0.826; p < 0.001), while BMI demonstrated limited predictive ability (AUROC 0.612; p = 0.221). A VAT cutoff of ≥ 65.9 cm2 predicted CR-POPF with a sensitivity of 86.7% and specificity of 72.7%.

Conclusion

Visceral adipose tissue is a superior predictor of clinically relevant postoperative pancreatic fistula compared with BMI in this Indian cohort. Traditional weight-based indices such as BMI may underestimate surgical risk in patients with occult visceral adiposity. Preoperative CT-based quantification of VAT may therefore provide a more precise method for identifying high-risk patients. Larger multicenter studies are warranted to validate these findings.