Impact of preoperative body weight on short-term and long-term prognosis after pancreatic resection for pancreatic ductal adenocarcinoma: a multicenter study

Background: The prognostic implications of preoperative body mass index (BMI) in patients undergoing curative-intent pancreatic resection for pancreatic ductal adenocarcinoma (PDAC) remain poorly characterized, with existing evidence demonstrating contradictory findings. This multicenter cohort study comprehensively analyzes the association between BMI stratification and both perioperative outcomes and long-term survival in PDAC patients receiving surgical intervention. Methods: ). Demographic parameters, operative profiles, and postoperative outcomes of the patients were compared. Univariable and multivariable analyses were performed to investigate the risk factors for short-term and long-term outcomes after pancreatic resection for PDAC. Results: Multivariable analyses revealed that both low-BMI and high-BMI were associated with significantly elevated mortality [odds ratio (OR) 4.952, 95% confidence interval (CI): 1.238-19.799, P=0.02, and OR 3.911, 95% CI: 1.134-13.491, P=0.03] and overall morbidity (OR 2.008, 95% CI: 1.149-3.509, P=0.01, and OR 1.820, 95% CI: 1.191-2.783, P=0.006). In addition, multivariable Cox-regression analyses revealed that both preoperative low-BMI and high-BMI were independent predictors of OS [hazard ratio (HR) 1.410, 95% CI: 1.049-1.896, P=0.02 and HR 1.609, 95% CI: 1.274-2.034, P<0.001] and RFS (HR 1.395, 95% CI: 1.050-1.853, P=0.02 and HR 1.575, 95% CI: 1.249-1.987, P<0.001). Conclusions: Patients with low-BMI and high-BMI demonstrate a significantly worse prognosis compared to those with normal-BMI following pancreatic resection for PDAC.