The effects of sarcopenia and sarcopenic obesity after pancreaticoduodenectomy in patients with pancreatic head cancer

Ryu, Yoshinori; Shin, Sang Hyun; Kim, Jae‐Hun; Jeong, Woo Kyoung; Park, Dae J.; Kim, Naru; Heo, Jin Seok; Choi, Dong Wook; Han, In Woong

doi:10.1016/j.hpb.2020.04.004

Cited by 33 publications

(22 citation statements)

References 51 publications

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“…All CT images were evaluated at the portal phase of the CT scan. The program used in this study was developed in the Department of Radiology at Samsung Medical Center and allowed for evaluation of muscle, visceral fat, and subcutaneous fat, and CT images of body composition were evaluated using MATLAB version R2010a (MathWorks Inc., Natick, MA, USA) [ 16 ]. Muscle, visceral fat, and subcutaneous fat were identified on pre-processed CT images using fuzzy c-means clustering algorithms.…”

Section: Methodsmentioning

confidence: 99%

Adverse Effects of Sarcopenic Obesity on Postoperative Complications after Major Hepatectomy in Patients with Hilar Cholangiocarcinoma

Lee

Shin

Ryu

et al. 2022

JCM

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Sarcopenic obesity (SO), which is defined as a high ratio of visceral adipose tissue to skeletal muscle, is a well-known risk factor for post-hepatectomy outcomes in patients with hepatocellular carcinoma. However, few studies have evaluated the effect of SO on postoperative outcomes in patients with hilar cholangiocarcinoma (CCC). This retrospective study aimed to evaluate the effect of preoperative SO on postoperative outcomes in patients with hilar CCC following major hepatectomy. Preoperative SO was assessed in 328 patients undergoing hepatectomy for hilar CCC at three institutions between 2006 and 2016. SO was calculated from cross-sectional visceral fat and muscle area displayed on preoperative CT imaging. Preoperative SO was present in 98 patients (29.9%). The major complication rate in patients with SO was higher than in those without SO (54.1% vs. 37.0%, p = 0.004). Additionally, postoperative hospital stays were prolonged in patients with SO (18.5 vs. 16.5 days, p = 0.038). After multivariable analysis, SO was identified as an independent risk factor for major complications after hepatectomy in hilar CCC patients (OR = 0.866, 95% CI: 1.148–3.034, p = 0.012). Careful postoperative management is needed after major hepatectomy in hilar CCC patients with SO.

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Section: Methodsmentioning

confidence: 99%

Adverse Effects of Sarcopenic Obesity on Postoperative Complications after Major Hepatectomy in Patients with Hilar Cholangiocarcinoma

Lee

Shin

Ryu

et al. 2022

JCM

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“…Sarcopenia is another important parameter associated with postoperative complications, chemotherapy toxicities, and poor survival in cancers (11). Almost 20 to 65% of patients with LPDAC had preoperative sarcopenia (12), and a correlation with postoperative complications and worse survival was reported in some studies (13)(14)(15)(16). Nevertheless, the additive value of sarcopenia on the prognostic role of lymphopenia in PDAC has never been elucidated.…”

Section: Introductionmentioning

confidence: 99%

Additive Value of Preoperative Sarcopenia and Lymphopenia for Prognosis Prediction in Localized Pancreatic Ductal Adenocarcinoma

et al. 2021

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BackgroundSurgical resection with adjuvant chemotherapy is the only treatment that can provide long term survival in localized pancreatic ductal adenocarcinoma (LPDAC). Notwithstanding, recurrence occurs in the vast majority of patients and a better stratification of preoperative therapies is required. This study aimed to investigate preoperative immunological and nutritional factors to predict relapse-free survival (RFS) in patients with LPDAC.MethodsAnalyses were derived from all consecutive LPDAC patients treated with surgical resection at Besancon University Hospital, France, between January 2006 and December 2014 (n=146). Biological and nutritional parameters were recorded before and after surgery. The association of 24 baseline parameters with RFS was evaluated using univariate and multivariate Cox analyses. Based on the final model, a prognostic score was developed.ResultsLymphocyte count and body composition were available for 94 patients. In multivariate analysis, preoperative lymphopenia and sarcopenia (or a low muscle mass) were identified as independent prognostic factors for RFS. The score determined three groups with a median RFS of 5.6 months (95% confidence interval [CI] = 4.3 to 9.6 months) for high-risk group, corresponding to patients with lymphopenia; 11.5 months (95%CI = 9.8 to 13.9 months), and 21.2 months (95%CI = 9.9 to 55.3 months), for intermediate-(patient with sarcopenia without lymphopenia), and low-risk groups (no risk factor), respectively (p <0.001). Preoperative sarcopenia predicts the occurrence of postoperative lymphopenia in patients with a preoperative lymphocyte count above 1,000/mm3 (p = 0.0029).ConclusionsPreoperative lymphopenia and sarcopenia are pejorative prognostic factors in LPDAC and should be considered in the preoperative evaluation to stratify death risk in patients with LPDAC.

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“…Sarcopenia has been an important issue for the last decade because many reports have suggested its relation to various adverse outcomes such as poor physical performance and even mortality [ 18 , 19 ]. Particularly for patients undergoing surgery for GI tract malignancies, sarcopenia is a risk factor for postoperative complications or poor survival [ 8 , 20 ]. In this study, SO rather than sarcopenia was an independent risk factor for RFS.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnostic cut-off values for sarcopenia were based on a cohort study from a Korean national institution [ 14 ]: skeletal muscle index (SMI = skeletal muscle area at L3/height 2 ) < 50.18 cm 2 /m 2 for males and SMI < 38.63 cm 2 /m 2 for females. Sarcopenic obesity (SO) was defined as visceral fat area (VFA)/SMI ≥ 2.5 according to our previous study on the effect of SO in patients with pancreatic cancer [ 8 , 15 ]. The preoperative relationship between tumors and the following major vessels were also evaluated: common hepatic artery (CHA), superior mesenteric artery (SMA), portal vein (PV), and superior mesenteric vein (SMV).…”

Section: Methodsmentioning

confidence: 99%

“…For preoperative factors, inflammatory markers such as neutrophil-to-lymphocyte (NLR) ratio have been studied as prognosticators [ 6 , 7 ]. Additionally, the prognostic values of nutritional status including sarcopenia are under assessment [ 8 ]. Intraoperatively, estimated blood loss (EBL) and transfusion have been reported as independent risk factors for survival [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Development of Nomograms for Predicting Prognosis of Pancreatic Cancer after Pancreatectomy: A Multicenter Study

et al. 2022

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Surgical resection is the only curative treatment for pancreatic ductal adenocarcinoma (PDAC). Currently, the TNM classification system is considered the standard for predicting prognosis after surgery. However, the prognostic accuracy of the system remains limited. This study aimed to develop new predictive nomograms for resected PDAC. The clinicopathological data of patients who underwent surgery for PDAC between 2006 and 2015 at five major institutions were retrospectively reviewed; 885 patients were included in the analysis. Cox regression analysis was performed to investigate prognostic factors for recurrence and survival, and statistically significant factors were used for creating nomograms. The nomogram for predicting recurrence-free survival included nine factors: sarcopenic obesity, elevated carbohydrate antigen 19–9, platelet-to-lymphocyte ratio, preoperatively-identified arterial abutment, estimated blood loss (EBL), tumor differentiation, size, lymph node ratio, and tumor necrosis. The nomogram for predicting overall survival included 10 variables: age, underlying liver disease, chronic kidney disease, preoperatively found portal vein invasion, portal vein resection, EBL, tumor differentiation, size, lymph node metastasis, and tumor necrosis. The time-dependent area under the receiver operating characteristic curve for both nomograms exceeded 0.70. Nomograms were developed for predicting survival after resection of PDAC, and the platforms showed fair predictive performance. These new comprehensive nomograms provide information on disease status and are useful for determining further treatment for PDAC patients.

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The effects of sarcopenia and sarcopenic obesity after pancreaticoduodenectomy in patients with pancreatic head cancer

Cited by 33 publications

References 51 publications

Adverse Effects of Sarcopenic Obesity on Postoperative Complications after Major Hepatectomy in Patients with Hilar Cholangiocarcinoma

Adverse Effects of Sarcopenic Obesity on Postoperative Complications after Major Hepatectomy in Patients with Hilar Cholangiocarcinoma

Additive Value of Preoperative Sarcopenia and Lymphopenia for Prognosis Prediction in Localized Pancreatic Ductal Adenocarcinoma

Development of Nomograms for Predicting Prognosis of Pancreatic Cancer after Pancreatectomy: A Multicenter Study

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