Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology

Simonsen, Carsten; Heer, Pieter de; Bjerre, Eik Dybboe; Suetta, Charlotte; Højman, Pernille; Pedersen, Bente Klarlund; Svendsen, Lars Bo; Christensen, Jesper

doi:10.1097/sla.0000000000002679

Cited by 264 publications

(211 citation statements)

References 70 publications

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“…For example, low muscle mass is associated with an increased risk of major post-operative surgical complications [HR: 1.40, 95% CI: 1.20-1.64, P < 0.001], 86 and chemotherapy-related toxicity in patients with non-metastatic colorectal [odds ratio: 2.34, 95% CI: 1.04-5.24, P = 0.03], 87 and metastatic breast cancer [57 vs 18%, P = 0.02]. For example, low muscle mass is associated with an increased risk of major post-operative surgical complications [HR: 1.40, 95% CI: 1.20-1.64, P < 0.001], 86 and chemotherapy-related toxicity in patients with non-metastatic colorectal [odds ratio: 2.34, 95% CI: 1.04-5.24, P = 0.03], 87 and metastatic breast cancer [57 vs 18%, P = 0.02].…”

Section: The Future Of Randomized Clinical Trialsmentioning

confidence: 99%

“…Body composition can also be used as a prognostic biomarker to identify patients who are most likely to experience adverse events and toxicities from cancer-directed therapy. For example, low muscle mass is associated with an increased risk of major post-operative surgical complications [HR: 1.40, 95% CI: 1.20-1.64, P < 0.001], 86 and chemotherapy-related toxicity in patients with non-metastatic colorectal [odds ratio: 2.34, 95% CI: 1.04-5.24, P = 0.03], 87 and metastatic breast cancer [57 vs 18%, P = 0.02]. 88 Chemotherapy dosing currently utilizes body surface area, which does not account for the distribution of lean and adipose tissue throughout the body.…”

Section: Bridging the Gap To Understand How Body Composition Can Be Imentioning

confidence: 99%

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The evolution of body composition in oncology—epidemiology, clinical trials, and the future of patient care: facts and numbers

Brown

Feliciano

Caan

2018

J cachexia sarcopenia muscle

121

115

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There is growing interest from the oncology community to understand how body composition measures can be used to improve the delivery of clinical care for the 18.1 million individuals diagnosed with cancer annually. Methods that distinguish muscle from subcutaneous and visceral adipose tissue, such as computed tomography (CT), may offer new insights of important risk factors and improved prognostication of outcomes over alternative measures such as body mass index. In a meta‐analysis of 38 studies, low muscle area assessed from clinically acquired CT was observed in 27.7% of patients with cancer and associated with poorer overall survival [hazard ratio: 1.44, 95% CI: 1.32–1.56]. Therapeutic interventions such as lifestyle and pharmacotherapy that modify all aspects of body composition and reduce the incidence of poor clinical outcomes are needed in patients with cancer. In a meta‐analysis of six randomized trials, resistance training exercise increased lean body mass assessed from dual‐energy X‐ray absorptiometry [mean difference (MD): +1.07 kg, 95% CI: 0.76–1.37; P < 0.001] and walking distance [MD: +143 m, 95% CI: 70–216; P < 0.001] compared with usual care control in patients with non‐metastatic cancer. In a meta‐analysis of five randomized trials, anamorelin (a ghrelin agonist) significantly increased lean body mass [MD: +1.10 kg, 95% CI: 0.35–1.85; P = 0.004] but did not improve handgrip strength [MD: 0.52 kg, 95% CI: −0.09–1.13; P = 0.09] or overall survival compared with placebo [HR: 0.99, 95% CI: 0.85–1.14; P = 0.84] in patients with advanced or metastatic cancer. Early screening to identify individuals with occult muscle loss, combined with multimodal interventions that include lifestyle therapy with resistance exercise training and dietary supplementation combined with pharmacotherapy, may be necessary to provide a sufficient stimulus to prevent or slow the cascade of tissue wasting. Rapid, cost‐efficient, and feasible methods to quantify muscle and adipose tissue distribution are needed if body composition assessment is to be integrated into large‐scale clinical workflows. Fully automated analysis of body composition from clinically acquired imaging is one example. The study of body composition is one of the most provocative areas in oncology that offers tremendous promise to help patients with cancer live longer and healthier lives.

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Section: The Future Of Randomized Clinical Trialsmentioning

confidence: 99%

Section: Bridging the Gap To Understand How Body Composition Can Be Imentioning

confidence: 99%

The evolution of body composition in oncology—epidemiology, clinical trials, and the future of patient care: facts and numbers

Brown

Feliciano

Caan

2018

J cachexia sarcopenia muscle

121

115

View full text Add to dashboard Cite

show abstract

“…Although optimal cutoff values of muscle mass to define sarcopenia should be elucidated (36), the recent review has highlighted that many studies fail to account for the variation introduced by factors such as sex, race, and tumor stage (37,38). Therefore, it would be prudent to define sarcopenia by setting the most appropriate cutoff value for each cohort studied.…”

Section: Abstract Sarcopenia Is a Complex Syndrome Defined Bymentioning

confidence: 99%

Clinical Impact of Sarcopenia on Gastric Cancer

et al. 2019

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“…It is well known that preoperative physical status, comorbidities, and biomarkers of metabolic and physiological status, such as albumin, are associated with surgical morbidity and mortality risk [22][23][24]. Metabolic status evaluated by laboratory data such as the prognostic nutritional index and patients' frailty, assessed by sarcopenia, have been associated with surgical complications risk and the prognosis in patients with cancers [25][26][27]. Furthermore, it should be noted that prognosis in patients with cancer depends not only on tumor-specific pathological factors but also on host-related factors, in particular, systemic inflammatory response [28].…”

Section: Discussionmentioning

confidence: 99%

The Controlling Nutritional Status Score and Postoperative Complication Risk in Gastrointestinal and Hepatopancreatobiliary Surgical Oncology: A Systematic Review and Meta-Analysis

Takagi¹,

Domagała²,

Polak

et al. 2019

Ann Nutr Metab

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The controlling nutritional status (CONUT) score is associated with prognosis in gastrointestinal (GI) cancer patients, but the clinical significance of the CONUT score for postoperative short-term outcome remains controversial. The aim of this study was to investigate the impact of the CONUT score on postoperative outcomes in patients with GI and hepatopancreatobiliary (HPB) cancers. We conducted a systematic literature search of Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Meta-analyses were performed to estimate the pooled risk ratio (RR) for postoperative complications in patients with lower CONUT score versus higher CONUT score. Furthermore, we explored the most appropriate cutoff value of the CONUT score to predict postoperative complications. Ten retrospective studies (5,138 patients) were included in this meta-analysis. Patients with higher CONUT score had an increased risk of mortality (RR 5.38, 95% CI 2.19–13.2, p < 0.001, I² = 0%), postoperative major complications (RR 1.56, 95% CI 1.05–2.33, p= 0.03, I² = 79%), and overall complications (RR 1.38, 95% CI 1.16–1.63, p < 0.001, I² = 6%). We found that the cutoff of CONUT ≤4 vs. CONUT ≥5 had the highest pooled RR compared with other cutoff values (RR 4.79, 95% CI 0.97–23.5, p= 0.05, I² = 91%). In conclusion, the present study suggests that the preoperative CONUT score was associated with an increased risk of mortality and complications in GI and HPB surgical oncology. Patients with higher CONUT score as compared with those having a lower score had approximately a fivefold mortality risk and an increased risk up to 55% on major and overall complications after GI and HPB surgery. Our analysis indicates that the appropriate cutoff value of the CONUT score to predict postoperative major complications would be between 4 and 5. The preoperative evaluation of the CONUT score would be helpful for predicting the risk of postoperative outcomes.

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Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology

Cited by 264 publications

References 70 publications

The evolution of body composition in oncology—epidemiology, clinical trials, and the future of patient care: facts and numbers

The evolution of body composition in oncology—epidemiology, clinical trials, and the future of patient care: facts and numbers

Clinical Impact of Sarcopenia on Gastric Cancer

The Controlling Nutritional Status Score and Postoperative Complication Risk in Gastrointestinal and Hepatopancreatobiliary Surgical Oncology: A Systematic Review and Meta-Analysis

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