Poster Presentation The Pancreas Summit 2025

Sarcopenia and frailty as prognostic indicators in patients undergoing resection for pancreatic adenocarcinoma (#32)

Mukund Karthik 1 2 3 4 , Jin-Soo Park 1 2 4 , Doruk Seyfi 1 2 4 , Angus Waldon 2 4 , Christian Ratnayake 2 4 , Jia Yin Lu 2 4 , James Morkaya 1 , Jarrah Spencer 4 , Charbel Sandroussi 1 2 3 4 5
  1. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, 2050, Australia
  2. Faculty of Medicine and Health (FMH), The University of Sydney, Sydney, NSW, Australia
  3. Upper GI Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  4. The University of Sydney, Sydney, NSW, Australia
  5. Upper GI Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia

Background and Aims:

Curative treatment for pancreatic ductal adenocarcinoma (PDAC) requires surgical resection. Proximal PDAC are typically treated with pancreaticoduodenectomy (PD), a low-volume, high-risk procedure with high morbidity and mortality. Successful surgery requires consideration of tumour biology, as well as individual patient characteristics. Sarcopenia is a clinical syndrome defined by generalised muscle wasting secondary to malnutrition, inflammation and inactivity.1 It is common in the elderly and has been associated with adverse clinical outcomes in other oncological cohorts, e.g. colorectal, oesophageal, and lymphoma.2

 

This study aimed to assess the utility of preoperative radiologic sarcopenia and frailty assessment on short- and long-term outcomes following PD.

 

Methodology:

Radiologic assessment of Skeletal Muscle Index (SMI) was performed using preoperative computed tomography and was calculated for all patients undergoing PD between 2016 and 2024 in two high-volume pancreatic resection centres. Sarcopenia was defined as <52.4cm2/m2 in Males, <38.5cm2/m2 in Females.3

 

Results:

147 patients (median age 75 years) were included. 32% were sarcopenic. Sarcopenics had no significant difference in postoperative complications, however had a significant difference in 1-year overall survival (p=0.006) and 1-year disease free survival (p=0.03). Restricted mean survival time showed that non-sarcopenics survived 52 days longer in the first year on average (p=0.003). There were no differences found after one year.

 

Conclusion:

Sarcopenia in PDAC is associated with worse survival outcomes in the first year postoperatively, however this difference ceases beyond one year. Frailty and sarcopenia are both easily assessable parameters, which can be evaluated preoperatively to risk-stratify patients prior to surgery. By retrospectively evaluating these measures on postoperative morbidity and mortality at two major Australian centres, it will help surgeons to individualise patient management in the context of PDAC, such as by recommending specific prehabilitation.

 

 

  1. Ratnayake CBB, Wells C, Olsson M, et al. Sarcopenic obesity and post-operative morbidity after pancreatic surgery: a cohort study. ANZ J Surg 2019; 89: 1587–1592.
  2. Thormann M, Hinnerichs M, Barajas Ordonez F, et al. Sarcopenia is an Independent Prognostic Factor in Patients With Pancreatic Cancer - a Meta-analysis. Acad Radiol 2023; 30: 1552–1561.
  3. Prado CMM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 2008; 9: 629–635.