Impact of sarcopenia on outcomes of patients undergoing pancreatectomy

Abstract

To evaluate the prevalence of sarcopenia in patients undergoing pancreatic surgery and to examine its impact on the surgical outcomes and survival of patients.Skeletal muscle index (SMI) was measured on preoperative CT. A patient was considered sarcopenic if SMI was <38.5 cm2/m2 for a female or <52.4 cm2/m2 for a male. Postoperative pancreatic fistula (POPF) and severe morbidity (Clavien≥3) were analyzed. Survival of patients with cancer was calculated using the Kaplan–Meier method.In total, 107 consecutive patients were included. Among them, 50 (47%) patients were sarcopenic and 65 (60%) were undernourished. The rates of severe morbidity and mortality were comparable between sarcopenic and nonsarcopenic groups. However, all POPF grade B or C and deaths occurred in the sarcopenic or nonsarcopenic overweight group (BMI > 25) with significantly lengthened hospital stays (P = .003). After pancreatectomy for cancer, 31 (40.2%) patients showed postoperative recurrence and 23 (29.9%) died after a median follow-up of 15 ± 13.5 months. Despite comparable histological types and stages, the median overall and disease-free survivals were lower in sarcopenic patients (16 months vs not reached, P = .02 and 11.1 months vs 22.5 months; P = .04, respectively). The multivariate analysis revealed that, sarcopenia trended to increase the risk of death (HR = 2.04, P = .07).Sarcopenia negatively impacted short- and long-term outcomes in patients undergoing pancreatectomy.

Body Composition Influences Post-Operative Complications and 90-Day and Overall Survival in Pancreatic Surgery Patients

“…Most studies that have addressed the relationship between body composition and the clinical outcome of pancreatic surgery patients focused mainly on skeletal muscle tissue and OS, with contradictory results. The studies have approached this issue using different methods to tackle skeletal muscle tissue, namely L3 CT scan-derived sarcopenia [4, 10, 16, 29], SMA loss [30], accelerated loss of muscle mass [20], total psoas area [1, 11] and volume [5], which have been associated with shorter OS in pancreatic cancer patients submitted to surgery or palliative care.…”

“…The thresholds for CT image-derived body composition parameters to define sarcopenia and low muscle radiation attenuation have been determined for a population with mixed cancer disease locations [16, 18] whereas those for visceral obesity have been obtained from obesity-related research [19, 20]. The above-mentioned thresholds for sarcopenia and low muscle radiation attenuation have already been used in pancreatic cancer patients [3, 4, 12, 13, 21, 22]. Besides this, candidate thresholds for sarcopenia based on SMA/body surface area (BSA) have been determined for gastric cancer patients [23].…”

“…With regard to nutritional status, recent studies have suggested that body composition phenotypes may influence postoperative and long-term clinical outcomes. Most studies have focused primarily on the impact of sarcopenia (low skeletal-muscle mass) on major postoperative complications [3] and overall survival (OS) [1, 4-12], and secondarily on visceral adipose tissue [3, 8, 10, 13] and low muscle radiation attenuation (a marker of fat infiltration of skeletal muscle) [9-11, 13]. Although some of these studies have included body mass index (BMI) [4, 12] as a proxy of body fatness, the influence of skeletal muscle infiltration by adipose tissue as well as the proportion of visceral adipose tissue with regard to skeletal-muscle tissue has been strikingly less studied.…”

The prevalence of sarcopenia in patients with chronic pancreatitis: a meta-analysis

“…В итоге 7 оригинальных исследований, отвечающих критериям, включены в настоящий метаанализ (см. таблицу) [13,[15][16][17][18][19][20].…”

Clinical Value of Muscle Mass Assessment in Clinical Conditions Associated with Malnutrition

“…Association between low muscle mass and clinical outcomes in solid tumor cancer patients [53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71]. Muscle mass was quantified by computed tomography at the L3 level except for references [56] and [71] for which bioelectrical impedance analysis and mid-arm muscle circumference were respectively used.…”