Adverse Effects of Preoperative Sarcopenia on Postoperative Complications of Patients With Gastric Cancer

Abstract

Background: Sarcopenia is known to have an important influence on postoperative complications in several diseases, and on the prognosis of patients with cancer. However, whether sarcopenia is associated with complications and prognosis after gastrectomy in patients with gastric cancer remains controversial. This study evaluated the impact of the preoperative muscle mass on postoperative complications of gastric cancer surgery. Materials and Methods: The muscle mass of 153 patients who underwent gastrectomy for gastric cancer from January 2014 to August 2016 was assessed before surgery by a multifrequency bioelectrical impedance analysis (In Body 3.0; Biospace, Tokyo, Japan) and was expressed as the muscle mass index (MMI). Sarcopenia was defined as an MMI value of one standard deviation or more below the gender-specific mean MMI. Complications of Clavien-Dindo grade 2 or more were defined as significant postoperative complications. The impact of preoperative sarcopenia on postoperative infectious complications was analyzed by univariate and multivariate analyses. Results: A total of 153 patients were analyzed, sarcopenia was present in 24 out of 153 patients (15.7%). Thirty (19.6%) patients developed postoperative complications, 20 (13.1%) of which were infectious complications. Sarcopenia was significantly associated with age, body mass index, serum albumin, pulmonary disease in comorbidities, operative time, surgical approach, and postoperative complications. The univariate analyses revealed that male sex, sarcopenia, total gastrectomy, laparotomy, and intraoperative blood loss were associated with postoperative infectious complications. In the multivariate analyses, sarcopenia and intraoperative blood loss ≥400 ml were independently associated with postoperative infectious complications. Conclusion: Preoperative sarcopenia was found to be an independent risk factor for postoperative infectious complications in gastric cancer patients.Despite recent advances in surgical procedures and perioperative management techniques, postoperative complications sometimes occur after gastrectomy in patients with gastric cancer. Several factors, such as older age and a low nutrition status, have been identified as risk factors for postoperative complications of gastric cancer surgery.Sarcopenia, a newly identified marker of frailty, is characterized by decreased muscle mass and a low muscle strength and function by the European Working Group on Sarcopenia in Older People (EWGSOP) (1). Sarcopenia is known to have an important influence on postoperative complications in several diseases (2-9) and on the prognosis of patients with cancer (2, 10-12).Bioelectrical impedance analysis (BIA) is a safe, easy and non-invasive method for evaluating body composition (13,14). The measurement of body composition by BIA is reported to be useful for evaluating the preoperative nutritional status of patients and in predicting outcomes (5, 15). However, few studies have evaluated the association between the preoperative muscle mass, as measure...

Sarcopenia as a prognostic factor for survival in patients with locally advanced gastroesophageal adenocarcinoma

“…In our cohort, perioperative complications, assessed by Clavien-Dindo score, occurred more frequently in sarcopenic patients. Many other studies confirm this finding [10–13,23,25,29], while others show different results [9].…”

“…To the best of our knowledge, this is the first report on this finding. Other authors focused on patients undergoing surgery alone [13,16,19–23] or neoadjuvant chemotherapy [15,24] only, which does not reflect the current standard of care in Europe anymore. A recent meta-analysis also focused on surgical outcomes and survival.…”

Bioelectrical Impedance Analysis for the Assessment of Sarcopenia in Patients with Cancer: A Systematic Review

“…For articles that remained after the initial screen, 65 full texts were reviewed for eligibility. Ultimately, 24 studies were selected for inclusion in the systematic review-18 articles [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]47] and 6 abstracts [33, 44-46, 48, 53]-with a total of 3,607 patients. Table 2 provides an overview of included studies regarding number of study participants, cancer types, inclusion criteria, and stage of care when the BIA assessment was conducted.…”

“…In 13 studies, BIA-defined sarcopenia was associated with adverse clinical outcomes in adults with cancer [29,30,32,34,36,37,39,45,47,48,51,53]. Sarcopenia was associated with worse overall survival in five studies [27,34,42,48,51] and severe surgical complications (e.g., infection, hematological) in four studies [30,32,37,47]. Other outcomes included worse pathological response in patients with esophageal cancer treated with chemotherapy [36], worse inflammatory response in patients with esophageal cancer treated with surgery [34] (which may preclude worse surgical response, e.g., more infections, higher reoperation rates), and higher patient-reported pain, fatigue, insomnia, and constipation [42].…”

SARC-CalF-assessed risk of sarcopenia and associated factors in cancer patients

“…In the multivariate linear regression analysis, considering the SARC-CalF score as the dependent variable, the variables BMI, HGSND and PG-ASG score, which explain 60 % of the SARC-CalF score, remained in the final model (Table IV) In sarcopenic patients, the amount of available amino acids is insufficient for tissue repair, which leads to delayed healing and consequently infectious complications (22,24). With the reduction in skeletal muscle mass and increase in adipose tissue, a process known as myosteatosis, an imbalance in the production of anti-inflammatory and pro-inflammatory cytokines is triggered, resulting in a proinflammatory state with weakening of the immune system (22,24).…”