A semi-automated assessment of sarcopenia using psoas area and density predicts outcomes after pancreaticoduodenectomy for pancreatic malignancy

Namm, Jukes P.; Thakrar, Kiran H.; Wang, Chi‐Hsiung; Stocker, Susan J.; Sur, Malini D.; Berlin, Jonathan W.; Dale, William; Talamonti, Mark S.; Roggin, Kevin K.

doi:10.21037/jgo.2017.08.09

Cited by 37 publications

(39 citation statements)

References 35 publications

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“…Muscle Hounsfield units measured on CT scans can be used to predict muscle density, which represents the intra-muscular adipose infiltration. 41 It has been shown to correlate with adverse outcomes in patients undergoing pancreatic surgery, 7,42 but in our study, we did not find an association between lower muscle density and worse outcomes. But PMD decreased significantly after the operation, which represented higher fat infiltration in muscle or myosteatosis because of the inflammation-induced consumption of muscle protein and fat deposition.…”

Section: Discussioncontrasting

confidence: 74%

“…4 , 5 A recent European consensus definition of sarcopenia described computed tomography (CT) as the gold standard for estimating muscle mass and some research also showed that CT-determined sarcopenia linked to poor outcomes following pancreatic surgery. 6 , 7 Sarcopenic overweight/obesity is another clinical problem characterized by the coexistence of overweight or obesity and sarcopenia which has been proven to be a strong predictor of major complications after pancreatoduodenectomy. 8 , 9 So, the International Study Group of Pancreatic Surgery recommend assessment of both sarcopenia and sarcopenic obesity prior to pancreatic surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Xu¹,

Li²,

Zhang³

et al. 2020

RMHP

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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.

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Section: Discussioncontrasting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

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

Xu¹,

Li²,

Zhang³

et al. 2020

RMHP

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“…Van Dijk et al could link a low MA to reduction of survival in 199 patients [29]. Namm et al showed similar results applying a semi-automated technique in 116 patients [33]. Sui et al linked sarcopenia as defined by total muscle area to the 5 year survival [34].…”

Section: Discussionmentioning

confidence: 99%

Power of computed-tomography-defined sarcopenia for prediction of morbidity after pancreaticoduodenectomy

Linder¹,

Schaudinn²,

Langenhan³

et al. 2019

BMC Med Imaging

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Background The goal of our study was to evaluate the current approach in prediction of postoperative major complications after pancreaticoduodenectomy (PD), especially symptomatic pancreatic fistula (POPF), using parameters derived from computed tomography (CT). Methods Patients after PD were prospectively collected in a database of the local department of surgery and all patients with CT scans available were assessed in this study. CT parameters were measured at the level of the intervertebral disc L3/L4 and consisted of the areas of the visceral adipose tissue (A VAT ), the diameters of the pancreatic parenchyma (DPP) and the pancreatic duct (DPD), the areas of ventral abdominal wall muscle (A MVEN ), psoas muscle (A MPSO ), paraspinal muscle (A MSPI ), total muscle (A MTOT ), as well as the mean muscle attenuation (MA) and skeletal muscle index (SMI). Mann-Whitney-U Test for two independent samples and binary logistic regression were used for statistical analysis. Results One hundred thirty-nine patients (55 females, 84 males) were included. DPD was 2.9 mm (Range 0.7–10.7) on median and more narrow in patients with complications equal to or greater stadium IIIb ( p < 0.04) and severe POPF ( p < 0.01). DPP median value was 17 (6.9–37.9) mm and there was no significant difference regarding major complications or POPF. A VAT showed a median value of 127.5 (14.5–473.0) cm 2 and was significantly larger in patients with POPF ( p < 0.01), but not in cases of major complications ( p < 0.06). A MPSO , A MSPI , A MVEN and A MTOT showed no significant differences between major complications and POPF. MA was both lower in groups with major complications ( p < 0.01) and POPF ( p < 0.01). SMI failed to differentiate between patients with or without major complications or POPF. Conclusion Besides the known factors visceral obesity and narrowness of the pancreatic duct, the mean muscle attenuation can easily be examined on routine preoperative CT scans and seems to be promising parameter to predict postoperative complications and POPF.

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“…The association between sarcopenia and postoperative complications including fistulas (a common and severe problem following PD) has also been shown [15e19]. In addition, Namm showed that following a pancreaticoduodenectomy, sarcopenic patients are more likely to be discharged to a nursing facility instead of independent living [19].…”

Section: Frailty Screening Tools and Hbp Surgerymentioning

confidence: 99%

Frailty assessment tools and geriatric assessment in older patients with hepatobiliary and pancreatic malignancies

Rostoft

Leeuwen

2021

European Journal of Surgical Oncology

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Background: The majority of patients with hepatobiliary and pancreatic (HBP) malignancies are older than 65 years. Due to the heterogeneity of this older population, decisions regarding surgical treatment cannot rely solely on treatment guidelines, but have to take into account patient frailty, geriatric impairments and resilience as well as patient preferences. In the few studies of older patients with HBP malignancies that have included a preoperative geriatric assessment (GA), frailty and elements from the GA such as reduced functional status have emerged as powerful predictors of postoperative morbidity and mortality, length of stay, type of treatment received and survival. A GA is a systematic evaluation of functional status, comorbidities, polypharmacy, cognition, nutritional status, emotional status, and social support. Materials and methods: A Pubmed search identifying clinical studies investigating the association between frailty, GA and outcomes in patients with HBP malignancies. Results: A total of 20 studies were included in this review. For HBP malignancies, the evidence linking frailty and GA variables to negative outcomes is limited, but generally shows that frailty, functional dependency, comorbidity, and sarcopenia predict postoperative complications and survival. Conclusion: Although scarcely investigated, frailty and elements from a GA seem to be associated with negative short-and long-term treatment outcomes in older patients with HBP malignancies. Future studies should investigate the impact of geriatric interventions and prehabilitation on outcomes.

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A semi-automated assessment of sarcopenia using psoas area and density predicts outcomes after pancreaticoduodenectomy for pancreatic malignancy

Cited by 37 publications

References 35 publications

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

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

Power of computed-tomography-defined sarcopenia for prediction of morbidity after pancreaticoduodenectomy

Frailty assessment tools and geriatric assessment in older patients with hepatobiliary and pancreatic malignancies

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