Periampullary cancers are located up to a maximum distance of 2 cm from the duodenal papilla, with pancreatic cancer being the most common. Despite advances in surgical technique, survival rates remain low, making it essential to identify prognostic factors. Visceral obesity has been identified as a risk factor for cancer development, but its influence on the morbidity and mortality of operated patients remains controversial. This study aims to identify an association between the presence of preoperative visceral obesity and an increased risk of postoperative morbimortality in patients with periampullary cancers at Hospital de Braga. The sample includes 44 patients with periampullary cancers who underwent surgery with a curative intention between January/2011 and April/2018. The area of visceral fat was measured using the ImageJ software. Statistical analysis was performed using the SPSS software version 25. Visceral fat was not implicated in longer hospital stay or postoperative complications. The survival analysis showed no differences in disease-free survival at 1 year (p = 0.121) and 5 years (p = 0.222) or in overall survival at 1 year (p = 0.163) and 5 years (p = 0.053) between groups. Our data suggest that preoperative visceral obesity is not a risk factor for greater postoperative morbidity and mortality in individuals with periampullary cancers. Despite the reduced sample, this study evaluates visceral obesity in four types of tumors with many similar characteristics. Additional studies with larger samples are needed to confirm our observations.


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1. Sarmiento JM, Nagomey DM, Sarr MG, Farnell MB. Periampullary cancers: are there differences? Surg Clin North Am. 2001;81(3):543-55.

2. Spalding DR, Pancreatic and periampullary cancers: treatment and outcome. Br J Hosp Med (Lond). 2006;67(1):14-20.

3. Yeo CJ, Sohn TA, Cameron JL, Hruban RH, Lillemoe KD, Pitt HA. Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg. 1998;227(6):821-31.

4. Vainio, Harri, et al., editores. International Agency for Research on Cancer Working Group on Evaluation of Cancer-Preventive Strategies. Weight Control and Physical Activity. IARC Press, 2002.

5. Organization, World Health, et al. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation. World Health Organization, 2003.

6. Moon, Hyeong-Gon, et al. «Visceral Obesity May Affect Oncologic Outcome in Patients with Colorectal Cancer». Annals of Surgical Oncology. 2008;15(7):1918-22.

7. Okamura, Akihiko, et al. «Clinical Impact of Abdominal Fat Distribution on Prognosis After Esophagectomy for Esophageal Squamous Cell Carcinoma». Annals of Surgical Oncology. 2016;23(4):1387-94.

8. Fujiwara, Naoto, et al. «Sarcopenia, Intramuscular Fat Deposition, and Visceral Adiposity Independently Predict the Outcomes of Hepatocellular Carcinoma». Journal of Hepatology. 2015;63:131-40.

9. Shuster, A., et al. «The Clinical Importance of Visceral Adiposity: A Critical Review of Methods for Visceral Adipose Tissue Analysis». The British Journal of Radiology. 2012;85:1-10.

10. Gaujoux, Sébastien, et al. «Impact of Obesity and Body Fat Distribution on Survival After Pancreaticoduodenectomy for Pancreatic Adenocarcinoma». Annals of Surgical Oncology. 2012;19(9):2908-16.

11. Okumura, Shinya, et al. «Visceral Adiposity and Sarcopenic Visceral Obesity Are Associated with Poor Prognosis After Resection of Pancreatic Cancer». Annals of Surgical Oncology. 2017;24(2):3732-40.

12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.

13. Sottier, D., Petit, J.-M., Guiu, S., Hamza, S., Benhamiche, H., Hillon, P., Guiu, B. Quantification of the visceral and subcutaneous fat by computed tomography: interobserver correlation of a single slice technique. Diagnostic and Interventional Imaging. 2013;94(9), 879–884.

14. Doyle, S. L., Bennett, A. M., Donohoe, C. L., Mongan, A. M., Howard, J. M., Lithander, F. E., ... Lysaght, J. Establishing computed tomography-defined visceral fat area thresholds for use in obesity-related cancer research. Nutrition Research (New York, N.Y.). 2013;33(3):171-179.

15. Benhamiche, A. M., et al. «Cancer of the Ampulla of Vater: Results of a 20-Year Population-Based Study». European Journal of Gastroenterology & Hepatology. 2000;12(1):75-79.

16. Berberat, P. O., et al. «An Audit of Outcomes of a Series of Periampullary Carcinomas». European Journal of Surgical Oncology (EJSO). 2009;35(2):187-91.

17. Uomo, Generoso. «Periampullary Carcinoma: Some Important News in Histopathology». JOP. Journal of the Pancreas. 2014;15(2).

18. Ilic, Milena, e Irena Ilic. «Epidemiology of pancreatic cancer». World Journal of Gastroenterology. 2016;22(44):9694-705.

19. De Pergola, Giovanni, e Franco Silvestris. «Obesity as a Major Risk Factor for Cancer». Journal of Obesity.2013p. 291546.

20. Pischon, Tobias, e Katharina Nimptsch. «Obesity and Risk of Cancer: An Introductory Overview». Recent Results in Cancer Research. Fortschritte Der Krebsforschung. Progres Dans Les Recherches Sur Le Cancer. 2016 ;208 :1-15.

21. Calle, Eugenia E., et al. «Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults». New England Journal of Medicine.2003;348(17):1625-38.

22. Genkinger, J. M., et al. «Central Adiposity, Obesity during Early Adulthood, and Pancreatic Cancer Mortality in a Pooled Analysis of Cohort Studies». Annals of Oncology. 2015;26(11):2257-66.

23. Xiao, J., Mazurak, V. C., Olobatuyi, T. A., Caan, B. J., & Prado, C. M. Visceral adiposity and cancer survival: a review of imaging studies. European Journal of Cancer Care. 2018;27(2), e12611.

24. Nakeeb, Ayman, et al. «Trends and Outcomes of Pancreaticoduodenectomy for Periampullary Tumours: A 25-Year Single-Center Study of 1000 Consecutive Cases». World Journal of Gastroenterology. 2017;23(38):7025-36.

25. Hatzaras, Ioannis, et al. «Predictors of Survival in Periampullary Cancers Following Pancreaticoduodenectomy». Annals of Surgical Oncology. 2010;17(4):991-97.

26. Santhosh, Sampath, et al. «Diagnostic Accuracy of F-18 FDG PET/CECT vs. CECT for Detecting Recurrence of Periampullary Carcinoma and Its Prognostic Significance». Abdominal Imaging. 2015;40(5):1131-37.
How to Cite
VALENTIM, Maria et al. IMPACT OF VISCERAL OBESITY ON OUTCOMES OF PERIAMPULLARY CANCER SURGERY. Revista Portuguesa de Cirurgia, [S.l.], n. 51, p. 45-52, feb. 2022. ISSN 2183-1165. Available at: <>. Date accessed: 21 may 2024. doi:
Original Papers