Estimating Fatty Pancreas: A Preoperative Bedside Assessment by Bioelectric Impedance Analysis: Implications for Pancreatic Surgery

Objective The aim of the study was to evaluate whether fatty pancreas could be estimated by fat mass measurement by preoperative bioelectric impedance analysis. Preoperative computed tomography scan and pathologic evaluation were used as validation methods. Moreover, the 3 methodologies were tested for their ability in predicting postoperative pancreatic fistula. Methods Seventy-five patients who underwent pancreatic resection were analyzed. Preoperative computed tomography attenuation in Hounsfield unit (CT-HU) was used to assess fatty pancreas. Bioelectric impedance analysis was performed the day before surgery and fat mass index (FMI) was calculated. Pancreatic steatosis was assessed by pathologists at the line of surgical transection. The ability of the methods in predicting postoperative pancreatic fistula was evaluated by the area under the receiver operating characteristics curves. Results There was a strong correlation between CT-HU values and grade of pancreatic steatosis evaluated at histology (r = -0.852, P < 0.001) and a moderate correlation between FMI and histologic pancreatic steatosis (r = 0.612, P < 0.001) and between CT-HU value and FMI (r = -0.659, P < 0.001) values. The area under the curve (95% confidence interval) was 0.942 (0.879-1) for histology, 0.924 (0.844-1) for CT-HU, and 0.884 (0.778-0.990) for FMI. Conclusions Bioelectric impedance analysis represents a valid alternative to assess pancreatic steatosis.