Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery?

Abstract

Sarcopenia, or loss of skeletal muscle mass and quality, has been studied as part of aging and adverse health outcomes in elderly patients but has only recently been evaluated as a separate condition in cancer patients and important indicator of adverse outcomes. Currently, its definition and method of assessment are still being debated. Sarcopenia within an increasingly obese population has led to a subgroup with sarcopenic obesity, at even higher risk of adverse outcomes. Yet, sarcopenia often goes undiagnosed in these patients, hidden beneath higher body mass index. Identifying sarcopenic and sarcopenic obese subpopulations would allow for more effective treatment plans and potential avoidance of suboptimal outcomes, as well as the chance to intervene and combat these modifiable risk factors. This review will examine available literature on the definition and methods of evaluating sarcopenia and sarcopenic obesity, summarize the effectiveness of sarcopenia and sarcopenic obesity as predictors of outcomes after gastrointestinal cancer surgery, including colorectal cancer resection, liver resection, and pancreatic resection, and outline strategies to minimize the impact of sarcopenia. It is clear that untreated sarcopenia and sarcopenic obesity can be associated with suboptimal post-operative outcomes, especially infections and disease-free or overall survival.

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

“…Our findings echo the current literature, as young, male patients were found to have higher muscle mass than elderly female patients (21,24,29). Previous authors have identified age-dependent, or primary, sarcopenia as a confounder in studies focused on sarcopenia secondary to cancer, like ours.…”

“…While TPA and BSA could significantly predict the development of acute radiation complications, BMI could not. BMI has been found to be a useful metric in outcomes related to obesity, and rarely has it found usefulness for low BMI (24,60). When dealing with a patient population that is generally underweight, we found no significant role for BMI regarding our selected outcomes.…”

“…TPA was significantly higher in young males, as was expected due to the gender and age difference (21,24). However, even after sub-group analysis was performed, neither TPA, BMI, nor BSA were significant predictors of overall survival.…”

“…The next best option is to use data from multiple studies using percentile based summative values. The literature currently uses a plethora of cohort-specific values, including using the lowest median, tertile, quartile, quintile, or standard deviation (19)(20)(21)23,24,27,28,(33)(34)(35)(36)(37)(38) in the study cohort. We validated our cohort's cutoff, by performing ROC curve analysis with regards to acute radiotoxicities which correlates to approximately a TPA of 500.…”

“…Previous studies investigated the association between pre-operative and post-operative TPA with outcomes in patients with pancreatic cancer (19)(20)(21)(22)(23)(24)(25). However, none have examined TPA prior to neoadjuvant therapy.…”