Original article Sarcopenia is associated with a greater incidence of delayed gastric emptying following pancreaticoduodenectomy James Tankel a, * , Amir Dagan a , Elena Vainberg b , Elad Boaz a , Liel Mogilevsky a , Irit Hadas b , Petachia Reissman a , Menahem Ben Haim a a Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel b Department of Radiology, Shaare Zedek Medical Centre, Jerusalem, Israel article info Article history: Received 17 May 2018 Accepted 26 May 2018 Keywords: Delayed gastric emptying Pancreaticoduodenectomy Complication summary Background and aims: Sarcopenia is the degenerative loss of skeletal muscle and has been associated with a variety of post-operative complications. We propose sarcopenia is associated with delayed gastric emptying (DGE) following elective pancreaticoduodenectomy (PD). Methods: A retrospective analysis of a computerised database maintained in real time of all patients undergoing PD within our hepatobiliary unit was performed. The cross-sectional area of the psoas muscle at the upper border of L3 was calculated and corrected for patient height. The lowest quartile of gender specific groups was considered to be sarcopenic. Results: 61 patients were included, 32 male and 29 female of whom 8 from each group were sarcopenic (26.2%). Although the sarcopenic and non-sarcopenia groups were found to be comparable, significantly more sarcopenic patients were older (75 vs 64 years, p ¼ 0.003), had a lower body mass index (21.9 vs 25.0 kg/m 2 ,p ¼ 0.003) and suffered from DGE (7/16 vs 8/45, p ¼ 0.045). On multivariate analysis, these variables maintained their significance with DGE having an OR of 6.042 (p ¼ 0.036). Conclusion: Sarcopenia is significantly associated with DGE, older age and lower BMI in this specific cohort of patients. Further research into the reversibility of this phenomenon is warranted. © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. 1. Introduction Pancreaticoduodenectomy (PD) is the mainstay of surgical treatment for localised pancreatic and periampullary malignancy [1]. However, despite the advancements in surgical technique and perioperative care, post-operative morbidity still affects up to 65% of patients [2]. Such complications can prevent the timely admin- istration of adjuvant therapies [3,4]. Alongside pancreatic fistula, delayed gastric emptying (DGE) is one of the leading causes of morbidity after PD. With incidence ranging between 8 and 45% [5] it serves as one of the main complications delaying further treatment. In order to align patient hopes with expectations and usher patients quickly towards adjuvant therapy, predicting and avoiding these complications is paramount. Whereas considerable ad- vancements have been made in identifying factors associated with pancreatic fistula following PD [6], efforts to predict patients at risk of DGE have been inconsistent [7]. It has been postulated that the cause of DGE is likely multifactorial and has been associated with intra-abdominal and respiratory complications [8,9], altered neuro- hormonal pathways [10] and approach to anatomical reconstruc- tion [11]. Yet none of these have been shown to consistently predict the incidence of DGE. A novel variable associated with post-operative complications in a variety of surgical fields is the presence of sarcopenia. Defined as loss of skeletal muscle resulting in decreased strength and general physical performance with impaired resilience to stress [12], sar- copenia is found in almost 80% of cancer patients [13,14]. It is associated with decreased survival and increased recurrence rates in multiple types of malignancy [15] including carcinoma of pancreatic origin [16,17]. Sarcopenia has also been associated with increased complications after PD including pancreatic fistula [18]. However, the relationship between this phenomenon and DGE is less well understood. Using single slice computed tomography (CT) to measure the cross sectional diameter of psoas muscle has been validated as * Corresponding author. Department of General Surgery, Shaare zedek Medical Centre, Shemuel Ba'it Street, Israel. E-mail address: jamietankel@hotmail.com (J. Tankel). Contents lists available at ScienceDirect Clinical Nutrition ESPEN journal homepage: http://www.clinicalnutritionespen.com https://doi.org/10.1016/j.clnesp.2018.05.011 2405-4577/© 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. Clinical Nutrition ESPEN xxx (2018) 1e5 Please cite this article in press as: Tankel J, et al., Sarcopenia is associated with a greater incidence of delayed gastric emptying following pancreaticoduodenectomy, Clinical Nutrition ESPEN (2018), https://doi.org/10.1016/j.clnesp.2018.05.011