{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T06:30:35Z","timestamp":1786516235110,"version":"build-2736575974"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005230","name":"Natural Science Foundation of Chongqing Municipality","doi-asserted-by":"publisher","award":["cstc2020jcyj-bshX0033"],"award-info":[{"award-number":["cstc2020jcyj-bshX0033"]}],"id":[{"id":"10.13039\/501100005230","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007957","name":"Chongqing Municipal Education Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007957","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"\n Introduction<\/jats:title>\n The combined role of preoperative sarcopenia and inflammatory response in patients undergoing pancreaticoduodenectomy (PD) remains unclear. This study investigates the predictive value of sarcopenia combined with inflammatory markers for postoperative overall survival (OS).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively analyzed 318 patients who underwent PD between February 2019 and March 2025. Sarcopenia was defined by CT-derived skeletal muscle index (SMI) using sex- and BMI-specific thresholds. Inflammatory markers included NLR, PLR, LMR and CAR. Optimal cutoffs were determined via ROC curves, and prognostic factors were identified using Cox proportional hazards models. Survival analysis was performed using the Kaplan\u2013Meier method.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 318 patients, 196 (61.64%) were diagnosed with preoperative sarcopenia. Multivariable analysis showed no significant association between sarcopenia or inflammatory markers and postoperative complications evaluated in this study (\n P<\/jats:italic>\n \u2009&gt;\u20090.05). CA19-9\n \n \n (<\/mml:mo>\n \n \n OR<\/mml:mi>\n <\/mml:mrow>\n :<\/mml:mo>\n 0.999<\/mml:mn>\n ,<\/mml:mo>\n P<\/mml:mi>\n =<\/mml:mo>\n 0.027<\/mml:mn>\n <\/mml:mrow>\n )<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n was a protective factor for POPF. SMI (OR: 1.165,\n P<\/jats:italic>\n \u2009=\u20090.041), neutrophils (OR: 1.191,\n P<\/jats:italic>\n \u2009=\u20090.005), and Operative blood loss (OR: 1.001,\n P<\/jats:italic>\n \u2009=\u20090.022) were independent risk factors for 30-day readmission. Multivariable analysis identified sarcopenia\n \n \n (<\/mml:mo>\n \n \n HR<\/mml:mi>\n <\/mml:mrow>\n =<\/mml:mo>\n 1.935<\/mml:mn>\n ,<\/mml:mo>\n P<\/mml:mi>\n =<\/mml:mo>\n 0.012<\/mml:mn>\n <\/mml:mrow>\n )<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n as an independent predictor of OS. Based on ROC curve analysis, the optimal cutoff values for NLR and CAR were exploratorily identified as 2.705 and 0.372. Survival analysis revealed that patients with sarcopenia combined with either high NLR (&gt;2.705) or high CAR (&gt;0.372) had significantly shorter mean OS compared to non-sarcopenic patients with low NLR or low CAR\n \n \n (<\/mml:mo>\n \n P<\/mml:mi>\n =<\/mml:mo>\n 0.007<\/mml:mn>\n ,<\/mml:mo>\n P<\/mml:mi>\n =<\/mml:mo>\n 0.001<\/mml:mn>\n <\/mml:mrow>\n )<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n . Specifically, the concurrent presence of sarcopenia and high NLR was associated with the highest mortality risk\n \n \n (<\/mml:mo>\n \n \n HR<\/mml:mi>\n <\/mml:mrow>\n =<\/mml:mo>\n 5.155<\/mml:mn>\n ,<\/mml:mo>\n P<\/mml:mi>\n =<\/mml:mo>\n 0.007<\/mml:mn>\n <\/mml:mrow>\n )<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n , followed by the combination of sarcopenia and high CAR\n \n \n (<\/mml:mo>\n \n \n HR<\/mml:mi>\n <\/mml:mrow>\n =<\/mml:mo>\n 2.808<\/mml:mn>\n ,<\/mml:mo>\n P<\/mml:mi>\n =<\/mml:mo>\n 0.001<\/mml:mn>\n <\/mml:mrow>\n )<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Preoperative sarcopenia is an independent predictor of poor OS following PD. The coexistence of sarcopenia and a high inflammatory state (i.e., high NLR or high CAR) significantly increases the risk of mortality. Therefore, preoperative assessment of skeletal muscle mass and inflammatory status may be crucial for identifying high-risk patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1855285","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:55:09Z","timestamp":1786514109000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic value of preoperative sarcopenia and inflammatory markers in patients undergoing pancreaticoduodenectomy"],"prefix":"10.3389","volume":"13","author":[{"given":"Hang","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JianJun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Dushan County People's Hospital, Dushan County, Qiannan Buyei and Miao Autonomous Prefecture","place":["Guizhou Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiuLin","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Clinical College, Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JiaHao","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WeiLong","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YuXue","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZhongPing","family":"Xu","sequence":"additional","affiliation":[{"name":"Clinical Nutrition Department, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YunBing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiong","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1097\/SLA.0000000000001660","article-title":"Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies","volume":"264","author":"de Rooij","year":"2016","journal-title":"Ann Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1007\/s11605-010-1326-4","article-title":"Redefining mortality after pancreatic cancer resection","volume":"14","author":"Carroll","year":"2010","journal-title":"J Gastrointest Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1002\/bjs.9420","article-title":"Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy","volume":"101","author":"Yoshioka","year":"2014","journal-title":"Br J Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1001\/jamasurg.2018.3213","article-title":"Association of hospital length of stay and complications with readmission after open pancreaticoduodenectomy","volume":"154","author":"Jiang","year":"2019","journal-title":"JAMA Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.ijsu.2018.11.016","article-title":"Postoperative complications in elderly patients following pancreaticoduodenectomy lead to increased postoperative mortality and costs. 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