Tomographic Sarcopenia Predicts Anastomotic Leaks and Long-Term Survival in Gastric Cancer Patients Operated With Curative Intent

Abstract

BACKGROUND: The preoperative nutritional state has prognostic postoperative value. Tomographic density and area of psoas muscle are validated tools for assessing nutritional status. There are few reports assessing the utility of staging tomography in gastric cancer patients in this field. AIMS: This study aimed to determine the influence of sarcopenia, measured by a preoperative staging computed tomography scan, on postoperative morbimortality and long-term survival in patients operated on for gastric cancer with curative intent. METHODS: This retrospective study was conducted from 2007 to 2013. The definition of radiological sarcopenia was by measurement of cross-sectional area and density of psoas muscle at the L3 (third lumbar vertebra) level in an axial cut of an abdominopelvic computed tomography scan (in the selection without intravascular contrast media). The software used was OsirixX version 10.0.2, with the tool “propagate segmentation”, and all muscle seen in the image was manually adjusted. RESULTS: We included 70 patients, 77% men, with a mean cross-sectional in L3 of 16.6 cm2 (standard deviation+6.1) and mean density of psoas muscle in L3 of 36.1 mean muscle density (standard deviation+7.1). Advanced cancers were 86, 28.6% had signet-ring cells, 78.6% required a total gastrectomy, postoperative surgical morbidity and mortality were 22.8 and 2.8%, respectively, and overall 5-year long-term survival was 57.1%. In the multivariate analysis, cross-sectional area failed to predict surgical morbidity (p=0.4) and 5-year long-term survival (p=0.34), while density of psoas muscle was able to predict anastomotic fistulas (p=0.009; OR 0.86; 95%CI 0.76–0.96) and 5-year long-term survival (p=0.04; OR 2.9; 95%CI 1.04–8.15). CONCLUSIONS: Tomographic diagnosis of sarcopenia from density of psoas muscle can predict anastomotic fistulas and long-term survival in gastric cancer patients treated with curative intent.

Palliative Gastrectomy Versus Gastric Bypass for Symptomatic Clinical Stage Iv Gastric Cancer: A Propensity Score Matching Analysis

“…Our finding regarding the longer survival for resected patients is in agreement with other reports 6,15,24,32,33 . However, some other studies have shown different results.…”

“…The description of the initial clinical characteristics of the patients in the present study corroborates this statement. However, progress in surgical technique and perioperative care has diminished this rate to less than 5% in recent studies 6 , 13 , 14 , 26 . In our study, palliative gastrectomy had a 30-day mortality rate of 5.7%.…”

“…However, there is a risk of complications related to the anastomoses and duodenal stump 5 . It is worth noting that most patients in this situation have significant weight loss with malnutrition and clinical frailty 6 . As an alternative, in cases where the lesions are unresectable or the patient is at high surgical risk, bypass procedures such as gastrojejunostomy and gastric partitioning can be used.…”

Quality of Life, Sarcopenia and Nutritional Status in Patients with Esophagogastric Tumors before and after Neoadjuvant Therapy

“…Sarcopenia and HRQoL are established risk factors for poor survival and tumor growth in upper GI tumors [ 10 , 12 , 19 , 41 , 62 , 63 , 64 , 65 , 66 , 67 ]. Sarcopenia has traditionally been measured through the CT-graphically obtained SMI, while HRQoL is obtained through patient questionnaires.…”

“…Another aspect recently gaining importance as a clinical prognostic factor in upper GI cancers is sarcopenia, which has not only been shown to be prognostic for progress-free and overall survival [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], but also reportedly correlates with postoperative complications like pneumonia, and might even influence anastomotic leakage [ 31 , 35 , 39 , 40 , 41 , 42 ]. Specifically, loss of skeletal muscle during neoadjuvant treatment has been suggested to raise anastomotic leakage rates, while chemotherapy, according to the FLOT protocol, has been shown to raise sarcopenia rates from 16% to 33% [ 40 , 43 ].…”