Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Abstract

Background Sarcopenia might function as an indicator for frailty, and as such as a risk factor for the development of postoperative complications. The aim of this study was to meta‐analyse the relation between preoperative sarcopenia and the development of severe postoperative complications in patients undergoing oncological surgery. Methods PubMed and Embase databases were systematically searched from inception until May 2018. Included were studies reporting on the incidence of severe postoperative complications and radiologically determined preoperative sarcopenia. Studies reporting the skeletal muscle as a continuous variable only were excluded. Data were extracted independently by two reviewers. Random effect meta‐analyses were applied to estimate the pooled odds ratio (OR) with 95% confidence intervals (95% CI) for severe postoperative complications, defined as Clavien‐Dindo grade ≥3, including 30‐day mortality. Heterogeneity was evaluated with I2 testing. Analyses were performed overall and stratified by measurement method, tumour location and publication date. Results A total of 1924 citations were identified, and 53 studies (14 295 patients) were included in the meta‐analysis. When measuring the total skeletal muscle area, 43% of the patients were sarcopenic, versus 33% when measuring the psoas area. Severe postoperative complications were present in 20%, and 30‐day mortality was 3%. Preoperative sarcopenia was associated with an increased risk of severe postoperative complications (ORpooled: 1.44, 95% CI: 1.24–16.8, P<0.001, I2=55%) and 30‐day mortality (ORpooled: 2.15, 95% CI: 1.46–3.17, P<0.001, I2=14%). A low psoas mass was a stronger predictor for severe postoperative complications compared with a low total skeletal muscle mass (ORpooled: 2.06, 95% CI: 1.37–3.09, ORpooled: 1.32, 95% CI: 1.14–1.53, respectively) and 30‐day mortality [ORpooled: 6.17 (95% CI: 2.71–14.08, ORpooled: 1.80 (95% CI: 1.24–2.62), respectively]. The effect was independent of tumour location and publication date. Conclusions The presence of low psoas mass prior to surgery, as an indicator for sarcopenia, is a common phenomenon and is a strong predictor for the development of postoperative complications. The presence of low total skeletal muscle mass, which is even more frequent, is a less informative predictor for postoperative complications and 30‐day mortality. The low heterogeneity indicates that the finding is consistent over studies. Nevertheless, the value of sarcopenia relative to other assessments such as frailty screening is not clear. Research is needed in order to determine the place of sarcopenia in future preoperative risk stratification.

Sarcopenia and mortality in different clinical conditions: A meta-analysis

“…The current comprehensive study investigated the effect of lean mass in more detail than previous studies. Previous meta-analyses evaluated the impact of lean mass on mortality in a particular population, such as people awaiting liver transplantation [ 7 , 8 ], or people with liver cirrhosis [ 10 ], tumors [ [11] , [12] , [13] , [14] ], and post-operation [ [15] , [16] , [17] , [18] , [19] ]. Some studies included less validated methods, such as phase angle [ 14 ] and mid-arm muscle [ 8 ] in the meta-analysis.…”

Phenotypic features of cancer cachexia‐related loss of skeletal muscle mass and function: lessons from human and animal studies

“…[33][34][35][36] Skeletal muscle mass loss has therefore been consistently associated with a decreased survival rate of cancer patients. 20,24,[31][32][33]35,[37][38][39][40] Cancer cachexia is a constantly developing area of great research interest. 41 Numerous clinical and experimental studies have thus been devoted to deciphering the molecular pathways involved in cancer cachexia, as well as developing strategies aimed at stopping or even reversing the loss of body mass and skeletal muscle mass loss (reviewed in literatures 5,[42][43][44][45][46][47][48][49] ).…”

Loss of skeletal muscle mass predicts cardiac death in heart failure with a preserved ejection fraction but not heart failure with a reduced ejection fraction

“…The psoas muscle provides postural support to the lumbar spine as well as the sacroiliac and hip joint, and it is the main flexor of the hip; as a result, it is strongly linked with physical performance in daily life. Furthermore, low PMI is strongly associated with poor short‐term and long‐term outcomes in cardiac and oncologic surgeries 8 . A systematic review suggests that psoas muscle mass is more strongly related to short‐term prognosis than total skeletal muscle mass according to CT‐based assessments in patients who underwent oncologic surgery 8 .…”

“…Furthermore, low PMI is strongly associated with poor short‐term and long‐term outcomes in cardiac and oncologic surgeries 8 . A systematic review suggests that psoas muscle mass is more strongly related to short‐term prognosis than total skeletal muscle mass according to CT‐based assessments in patients who underwent oncologic surgery 8 . Evaluation of PMI derived by CT is a useful objective and quantitative method for patients with ADHF.…”

“…Psoas muscle mass index (PMI) has received growing recognition as an objective and quantitative marker to assess loss of skeletal muscle mass and has been suggested as a useful predictive marker for long-term outcome in patients undergoing cardiovascular or oncologic surgeries. 8,9 On the other hand, the prognostic implications and risk stratification capability of PMI in patients with ADHF are currently unknown. Accordingly, the purpose of the present study was to investigate the long-term prognostic value of PMI in hospitalized patients with ADHF.…”