Obesity Does Not Influence Delayed Gastric Emptying Following Pancreatoduodenectomy

SIMPLE SUMMARY: Over the last decades the number of obese patients has been increasing. Not only is obesity associated with other diseases such as cardiovascular diseases, diabetes and asthma but obese patients are also at a higher risk for developing different types of cancers, for instance pancreatic cancer with a consecutive increased need for pancreatic surgery. Even though it is not life threatening, impaired gastric motility, also known as delayed gastric emptying, has still remained the most common complication after pancreatic surgery. However, the data about obesity on postoperative outcome after pancreatic surgery are inconsistent, specifically in relation to delayed gastric emptying. The goal of this study was to investigate the impact of obesity on postoperative outcome, specifically on delayed gastric emptying, after pancreatic surgery. Our data show no difference in the occurrence and severity of delayed gastric emptying in patients with obesity compared to non-obese patients. Moreover, the overall mortality rate did not differ between the two groups. In summary, our data show that obese patients are not put at a higher risk in regard to postoperative outcome, which makes pancreatic surgery a feasible procedure in the obese patient, specifically in relation to delayed gastric emptying. ABSTRACT: Background: The data about obesity on postoperative outcome after pancreatoduodenectomy (PD) are inconsistent, specifically in relation to gastric motility and delayed gastric emptying (DGE). Methods: Two hundred and eleven patients were included in the study and patients were retrospectively analyzed in respect to pre-existing obesity (obese patients having a body mass index (BMI) ≥ 30 kg/m(2) vs. non-obese patients having a BMI < 30 kg/m(2), n = 34, 16% vs. n = 177, 84%) in relation to demographic factors, comorbidities, intraoperative characteristics, mortality and postoperative complications with special emphasis on DGE. Results: Obese patients were more likely to develop clinically relevant pancreatic fistula grade B/C (p = 0.008) and intraabdominal abscess formations (p = 0.017). However, clinically relevant DGE grade B/C did not differ (p = 0.231) and, specifically, first day of solid food intake (p = 0.195), duration of intraoperative administered nasogastric tube (NGT) (p = 0.708), rate of re-insertion of NGT (0.123), total length of NGT (p = 0.471) or the need for parenteral nutrition (p = 0.815) were equally distributed. Moreover, mortality (p = 1.000) did not differ between the two groups. Conclusions: Obese patients do not show a higher mortality rate and are not at higher risk to develop DGE. We thus show that in our study, PD is feasible in the obese patient in regard to postoperative outcome with special emphasis on DGE.