Obesity is a major risk factor for adverse outcomes following pancreatectomy: results of a systematic review and meta-analysis
Hajibandeh, Shahin Westerman, Robyn Ali, Esha Tr Hajibandeh, Shahab Raza, Syed Soulat Bartlett, David C Chatzizacharias, Nikolaos Dasari, Bobby Vm Marudanayagam, Ravi Roberts, Keith J
Hajibandeh, Shahin
Westerman, Robyn
Ali, Esha Tr
Hajibandeh, Shahab
Raza, Syed Soulat
Bartlett, David C
Chatzizacharias, Nikolaos
Dasari, Bobby Vm
Marudanayagam, Ravi
Roberts, Keith J
Affiliation
University Hospitals Birmingham NHS Foundation Trust; Royal Stoke University Hospital; Swansea Bay University Health Board
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Publication date
2025-07-15
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Collections
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Abstract
Aims: To evaluate comparative outcomes of pancreatic resection in patients with or without obesity.
Methods: A systematic search of electronic data sources and bibliographic reference lists were conducted. All studies reporting comparative outcomes of pancreatic resections in patients with versus without obesity (Body Mass Index (BMI)≥30 kg/m2) were included and their risk of bias were assessed. Clinically-relevant postoperative pancreatic fistula (CR-POPF), Clavien-Dindo (C-D) ≥ III complications, overall perioperative morbidity, mortality, delayed gastric emptying (DGE), surgical site infections (SSIs), and conversion to open procedure were the evaluated outcome parameters.
Results: Twelve comparative studies were included reporting a total of 21,586 patients with (n = 5475) and without (n = 16,111) obesity who underwent pancreatic resection. Obesity was associated with significantly higher rate of CR-POPF (OR:1.97; 95 % CI 1.60-2.43, p < 0.00001), CD ≥ III complications (OR:1.85; 95 % CI 1.50-2.27, p < 0.00001), overall perioperative morbidity (OR 1.69; 95 % CI 1.28-2.23, p = 0.0002), postoperative mortality (OR:1.45; 95 % CI 1.15-1.83, p = 0.002), DGE (OR:1.19; 95 % CI 1.09-1.29, p = 0.0001), and SSI (OR:1.70; 95 % CI 1.17-2.49, p = 0.006) when compared with no obesity. Where minimally invasive approaches were considered, no significant difference was found in conversion to open procedure (OR:0.59; 95 % CI 0.25-1.40, P = 0.23) between two groups. Sub-group analyses for type of pancreatectomy and surgical approach were consistent with the main analyses.
Conclusions: The meta-analysis of best possible evidence indicates that obesity is associated with increased morbidity and mortality following pancreatic resection and should be included in risk predication models for short-term outcomes after pancreatic resections. Impact of different sub-types of obesity on outcomes requires further research.
Citation
Hajibandeh S, Westerman R, Ali ET, Hajibandeh S, Raza SS, Bartlett DC, Chatzizacharias N, Dasari BV, Marudanayagam R, Roberts KJ, Sutcliffe RP. Obesity is a major risk factor for adverse outcomes following Pancreatectomy: Results of a systematic review and meta-analysis. Pancreatology. 2025 Nov;25(7):1159-1168. doi: 10.1016/j.pan.2025.07.007. Epub 2025 Jul 15.
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Article