Treffer: Skeletal muscle mass associates with pancreaticoduodenectomy operative time in a sex-dependent manner.

Background: Pancreaticoduodenectomy, also known as the Whipple procedure, is a complex surgery for which increased operative time is associated with worse outcomes for patients. Body composition has been shown to be a contributing factor to operative time and can vary widely amongst pancreaticoduodenectomy patients. We hypothesized that greater amounts of adipose tissue are associated with extended pancreaticoduodenectomy operative time.
Methods: Demographic variables were retrieved retrospectively from the medical record for the first 211 consecutive patients enrolled in an institutional biobanking protocol with malignancies associated with pancreatectomy. Our final cohort of 68 patients underwent a pancreaticoduodenectomy and had preoperative CTs available for body composition analysis. Variables of interest were associated with operating time.
Results: Younger patient age, greater number of lymph nodes removed, and the need for a vascular repair were all associated with increased operative time. When considering surgeries without vascular repairs (n = 56), neither subcutaneous adipose (p = 0.80) nor visceral adipose (p = 0.32) were associated with surgery length. Skeletal muscle was unique, with greater muscle mass tending to associate with longer operating times (p = 0.051). Additionally, a sexual dimorphism was revealed whereby increased operative time was associated with greater skeletal muscle mass for females (p = 0.005) but lower skeletal muscle mass for males (p < 0.001).
Conclusions: Contrary to expectations, increased adiposity was not associated with extended pancreaticoduodenectomy operative time. However, skeletal muscle mass was associated with operative time in a sex-dependent matter. Assessment of skeletal muscle mass could prove useful in identifying patients at risk of prolonged pancreaticoduodenectomy operations.
(© 2025. The Author(s).)

Declarations. Ethics approval and consent to participate: Patients with cancer receiving care at the University of Iowa Health Care are approached to consent to research under the PERCH (Patients Enhancing Research Collaboration at Holden) program at the Holden Comprehensive Cancer Center. Gastrointestinal cancer patients consent to PERCH through the Gastrointestinal Molecular Epidemiology Resource, which has been approved by the University of Iowa Institutional Review Board (IRB # 201202742, first approved February 21, 2012). The research herein was conducted with the data of patients who provided informed consent to participate PERCH and related research. This specific research was approved under a waiver of consent by the University of Iowa Institutional Review Board (IRB # 202101083, first approved July 9, 2021), with appropriate protections of patient privacy in compliance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.