Are sarcopenia, obesity and sarcopenic obesity predictive of outcome in patients with colorectal liver metastases?

Lodewick, Toine M.; Nijnatten, Thiemo J A van; Dam, Ronald M. van; Mierlo, K. van; Dello, Simon A.W.G.; Neumann, Ulf; Damink, Steven W. M. Olde; Dejong, Cornelis H. C.

doi:10.1111/hpb.12373

Cited by 109 publications

(106 citation statements)

References 36 publications

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“…However, in a recent study, neither sarcopenia nor sarcopenic obesity was found to have an impact on survival after liver resection for CRC liver metastases [4]. In the same report, excessive body fat, estimated from measurements of skeletal mass areas on available computed tomography scans and body weight, correlated with improved overall and diseasefree survival [4], which is in accordance with our findings. On the other hand, among surgical patients those at the extremes of BMI (underweight and morbidly obese) have the highest postoperative mortality, which persists at long term [27].…”

Section: Discussionsupporting

confidence: 91%

“…Despite some inconsistency in the literature [4,9,10], several articles have shown an increased risk for perioperative complications in obese patients undergoing hepatectomy [2,5e7]. In our cohort, neither obesity nor diabetes was identified as a major predictor of perioperative morbidity or mortality.…”

Section: Discussionmentioning

confidence: 69%

“…It has been suggested that the "obesity paradox" is present in patients with cancer only when obesity is defined by BMI and that sarcopenia, that is reduced muscle mass, even in the presence of excessive fat mass (i.e., sarcopenic obesity), is a major predictor of poor survival [26]. However, in a recent study, neither sarcopenia nor sarcopenic obesity was found to have an impact on survival after liver resection for CRC liver metastases [4]. In the same report, excessive body fat, estimated from measurements of skeletal mass areas on available computed tomography scans and body weight, correlated with improved overall and diseasefree survival [4], which is in accordance with our findings.…”

Section: Discussionmentioning

confidence: 99%

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Differential impact of obesity and diabetes mellitus on survival after liver resection for colorectal cancer metastases

Amptoulach

Gross

Kalaitzakis

2015

Journal of Surgical Research

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Differential impact of obesity and diabetes mellitus on survival after liver resection for colorectal cancer metastases

Amptoulach

Gross

Kalaitzakis

2015

Journal of Surgical Research

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“…Peng et al reported an increase in severe post-operative complications in patients with colorectal cancer with sarcopenic obesity who underwent hepatic resection (18). However, Lodewick et al reported that sarcopenia and sarcopenic obesity did not impact complication rates in a similar study population (19). A meta-analysis of 14 studies linking sarcopenic obesity to clinical outcomes in cancer patients concluded that sarcopenic obesity was associated with increased surgical complications (14).…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia related to neoadjuvant chemotherapy and perioperative outcomes in resected gastric cancer: a multi-institutional analysis

Mirkin¹,

Luke²,

Gangi³

et al. 2017

J. Gastrointest. Oncol.

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Background: This study's objective was to evaluate the change in sarcopenia score following neoadjuvant chemotherapy (NAC) and to correlate both sarcopenia and change in score with perioperative outcomes in patients with advanced resected gastric cancer.Methods: Multi-institutional analysis of patients with gastric cancer who underwent NAC and resection from 2000-2015 was performed. Demographic and perioperative data were included. Sarcopenia score was defined as CT measurement of total psoas muscle at L3, stratified by height (m). Sarcopenia was defined as a score <385 mm 2 /m 2 in women and <545 mm 2 /m 2 in men.Results: Of 36 patients, 19% were sarcopenic prior to NAC. Following NAC, 31% were sarcopenic, with 14% developing sarcopenia during NAC. One patient (3%) became non-sarcopenic. There were no significant differences in patient, disease, or surgery characteristics between patients who were sarcopenic vs.not. Patients with sarcopenia were more likely to have post-operative complications (P=0.05). There was no significant difference in hospital stay (P=0.7402) or survival (P=0.2317).Conclusions: A significant number of patients with gastric cancer become sarcopenic during NAC.Although patients with sarcopenia were nearly twice as likely to develop post-operative complications, this did not appear to impact length of stay (LOS) or survival. and strength two standard deviations below that of healthy adults, has been used as a clinically significant marker of biological age, and has been found to be associated with functional impairment, perioperative complications, and decreased survival in patients with nonmalignant conditions (4-6). Changes in body composition on computed topography (CT) imaging occur after neoadjuvant treatment in many cancers, including esophageal and breast cancer (7)(8)(9)(10).This study sought to understand the impact of NAC on sarcopenia and to evaluate whether sarcopenia is correlated with perioperative outcomes in patients with advanced resected gastric cancer. Methods Patient selectionThis was a multi-institutional, retrospective cohort study. Records of patients who underwent NAC and surgery for gastric adenocarcinoma at Penn State Hershey Medical Center and Moffitt Cancer Center from March 2000 to April 2015 were reviewed. Only patients who had both pre-NAC and post-NAC CT or positron emission tomography (PET-CT) scans, were included in final analysis. Outcomes and covariatesPatient characteristics [including age, sex, body mass index (BMI), comorbidities, pre-operative weight], disease characteristics [American Joint Committee on Cancer (AJCC) T and N stage, tumor size, lymph nodes], and treatment characteristics (surgical approach, type of resection, NAC regimen, surgical margins) were retrospectively collected from the electronic medical record. Post-operative complications, hospital length of stay (LOS), and overall survival were the primary outcomes. Surgical complications were classified by the Clavien-Dindo Classification of Surgical Complications Scale, which grades com...

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“…Predefined cutoffs were adopted in 8 studies [11,20,[24][25][26][27][28]39], and optimum stratification, receiver operator characteristic curve and study-specific percentiles were used in the other studies [12-14, 21-23, 29-38, 40-42]. Sex-specific cutoffs were employed in almost all of the included studies, and on comparison with males, females showed a relatively lower muscle mass and MA (Table 3).…”

Section: Cutoff For the Sarcopenia Indexmentioning

confidence: 99%

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

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Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14–1.63; p = 0.0008; I² = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15–1.58; p = 0.0002; I² = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14–1.73; p = 0.002; I² = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28–2.09; p < 0.0001; I² = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.

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Are sarcopenia, obesity and sarcopenic obesity predictive of outcome in patients with colorectal liver metastases?

Abstract: Sarcopenia, obesity and sarcopenic obesity did not worsen DFS, OS and complication rates after a partial liver resection for CRLM.

Cited by 109 publications

References 36 publications

Differential impact of obesity and diabetes mellitus on survival after liver resection for colorectal cancer metastases

Differential impact of obesity and diabetes mellitus on survival after liver resection for colorectal cancer metastases

Sarcopenia related to neoadjuvant chemotherapy and perioperative outcomes in resected gastric cancer: a multi-institutional analysis

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

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