<p>Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy</p>

Abstract

Background and Aim: Sarcopenia has been proven to be a risk factor after pancreatoduodenectomy (PD). We aimed to evaluate if decreased psoas muscle area and density shown in CT scan, as measures for sarcopenia, were associated with postoperative major complications and adverse outcomes in patients who underwent PD. Patients and Methods: We analyzed 152 consecutive patients who underwent open PD. Total psoas area and muscle attenuation were measured on CT images at the level of the third lumbar vertebra. Total psoas area index (TPAI) was calculated, the cutoff values of TPAI were estimated and validated. The relationship between radiographic characters and outcomes was analyzed. Results: The optimal cutoff values of TPAI were 4.78 cm 2 /m 2 for males and 3.46 cm 2 /m 2 for females. The values were validated by outcomes with significant differences in the rate of major complications, re-operation, length of stay, and total cost. The prevalence of TPAIdefined sarcopenia and sarcopenic overweight/obesity was 38.8% and 17.1% in total. In multivariate logistic regression, rate of major complications was associated with TPAI [OR=0.605, 95% CI (0.414, 0.883), P=0.009], TPAI-defined sarcopenia [OR=8.256, 95% CI (2.890, 23.583), P=0.000] and sarcopenic overweight/obesity [OR=7.462, 95% CI (2.084, 26.724), P=0.002]; meanwhile, NRS2002-defined nutritional risk and GLIM-defined malnutrition did not show relationship with major complications. Conclusion: Both sarcopenia and sarcopenic overweight/obesity determined by new TPAI cutoff values were associated with a higher rate of major complications and adverse outcomes in Chinese patients undergoing open PD whereas usual nutritional assessment was not.

Sarcopenia assessed by total psoas index – is it correlated with post-operative complications in all digestive cancers?

“…found TPAI to be a strong predictor of overall as well as progression-free survival in patients with metastatic pancreatic cancer [14]. Xu et al studied Chinese patients undergoing open pancreatoduodenectomy [15]. The sarcopenia defined by TPAI index was associated with the occurrence of major complications and adverse outcomes, while the nutritional assessment was not [15].…”

“…[10], Kasahara et al [11], Kayano et al [12], Nakayama et al [13], Williet et al [14], Xu et al [15]) listed in table I.…”

“…Clear differentiation between muscles and surrounding tissue, completely visible muscle area without cuts, and lack of artifacts were the required criteria for the selected images to comply with quality indicators. Male patients (cm 2 /m 2 ) Cut-off 1 -Dodson et al [9] 3.38 4.77 Cut-off 2 -Jung et al [10] 4.43 8.18 Cut-off 3 -Kasahara et al [11] 2.07 2.49 Cut-off 4 -Kayano et al [12] 2.89 4.75 Cut-off 5 -Nakayama et al [13] 3.92 6.36 Cut-off 6 -Williet et al [14] 4.37 5.73 Cut-off 7 -Xu et al [15] 3.46 4.78…”

Use of computed tomography for the diagnosis of surgical sarcopenia: Review of recent research advances

“…Currently, SMI and TPI are the two commonly used quantitative indicators for abdominal CT. TPI is relatively easy to determine and is not affected by abdominal distension due to ascites or other factors 47,48 . Some studies have shown that TPI is a reliable index for diagnosis of CT‐defined sarcopenia in patients with liver cirrhosis, colorectal surgery, or pancreaticoduodenectomy 49–51 . However, some experts believe that because psoas major is only a small part of the muscle, whether it represents the overall muscle level of the patient needs further verification 52,53 .…”

“…47,48 Some studies have shown that TPI is a reliable index for diagnosis of CT-defined sarcopenia in patients with liver cirrhosis, colorectal surgery, or pancreaticoduodenectomy. [49][50][51] However, some experts believe that because psoas major is only a small part of the muscle, whether it represents the overall muscle level of the patient needs further verification. 52,53 Because SMI includes all muscles in the L3 plane, it is generally believed to better represent the overall muscle level of the patient; therefore, it is adopted by most researchers.…”