Effect of sarcopenia on the outcomes after pancreaticoduodenectomy for distal cholangiocarcinoma

Umetsu, Satoko; Wakiya, Taiichi; Ishido, Keinosuke; Kudo, Daisuke; Kimura, Norihisa; Miura, Takuya; Toyoki, Yoshikazu; Hakamada, Kenichi

doi:10.1111/ans.14304

Cited by 19 publications

(12 citation statements)

References 30 publications

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“…CT has a high degree of validity in determining body composition analysis and is the current gold standard for measuring fat and muscle mass . Unlike most previous studies on biliary tract cancer that measured only psoas muscle area, our study measured total skeletal muscle area on L3 vertebral level in assessing muscle quantity and quality. Psoas muscle includes only <10% of total trunk muscles: therefore, measuring only psoas muscle might not represent the whole skeletal muscle mass and failed to predict the clinical outcome of cancer patients in recent studies .…”

Section: Discussionmentioning

confidence: 99%

“…In case of biliary tract cancer, there have been a few studies analysing the relationship between prognosis and body composition, limited to a specific location of bile duct cancer (i.e. distal, perihilar, or intrahepatic bile ducts) . To date, there are no study analysing the impact of various body compositions on post‐operative long‐term prognosis by integrating whole biliary tract cancers.…”

Section: Introductionmentioning

confidence: 99%

“…distal, perihilar, or intrahepatic bile ducts). [18][19][20][21] To date, there are no study analysing the impact of various body compositions on post-operative long-term prognosis by integrating whole biliary tract cancers.…”

Section: Introductionmentioning

confidence: 99%

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Impact of preoperative body compositions on survival following resection of biliary tract cancer

Yoon

Choi

Song

et al. 2019

J cachexia sarcopenia muscle

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Background Although surgical resection is the only potentially curative treatment for biliary tract cancer, the prognosis remains poor after a major operation such as pancreatoduodenectomy or hepatectomy. We aimed to investigate the impact of preoperative body compositions on long‐term survival of patients undergoing resection of biliary tract cancer. Methods We analysed data of patients diagnosed with biliary tract cancer who underwent surgery from 2009 to 2015. Skeletal muscle area, skeletal muscle radiation attenuation, and visceral and subcutaneous adipose tissue areas were measured from the computed tomography images at L3 vertebral levels obtained before resection of cancer. Patients were divided into two groups based on the sex‐specific median values for each parameter, and long‐term survival was compared between the groups. Results A total of 371 patients (women, 39.6%; mean age, 66.2 ± 9.6 years) were finally included in the analysis. Patients with low skeletal muscle index (SMI) had significantly shorter median survival than those with high SMI (29 vs. 39 months; P = 0.026). Patients with low skeletal muscle attenuation (SMA) also showed reduced survival compared with those with high SMA (median survival 25 vs. 60 months; P = 0.002). Combining these two factors, survival was highest in the high SMI/high SMA group (reference) and lowest in the low SMI/low SMA group (hazard ratio, 2.18; 95% confidence interval, 1.44–3.30). Visceral and subcutaneous adipose tissue areas were not associated with long‐term survival. Conclusions Low SMI and low SMA on computed tomography scan have a negative impact on survival after resection of biliary tract cancer. They can be used in preoperative risk assessment to assist in treatment decision making.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of preoperative body compositions on survival following resection of biliary tract cancer

Yoon

Choi

Song

et al. 2019

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

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“…A recent study of a large cohort of patients with resected periampullary cancer ( 13 ) showed that patients with cholangiocarcinoma had a higher morbidity rate than those with pancreatic head cancer and that apparent biological differences existed between the 2 groups. Few studies have evaluated the risk of morbidity associated with only distal cholangiocarcinoma ( 19 ) and risk factors for postoperative complications after PD in patients with distal cholangiocarcinoma have not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil‑to‑lymphocyte ratio as a predictor of postoperative morbidity in patients with distal cholangiocarcinoma

et al. 2018

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Systemic inflammatory-, immunological- and nutritional-based indices, such as the neutrophil-to-lymphocyte ratio (NLR), the prognostic nutritional index (PNI) and the Glasgow prognostic score (GPS), are drawing considerable research attention to predict the long-term prognosis of many types of cancer. Recently, these parameters have also been reported to be useful in predicting postoperative morbidity in several fields, including colorectal and otolaryngological cancer. However, while distal cholangiocarcinoma exhibits a high morbidity rate, its risk factors of morbidity have not yet been established. This is because previous studies have analyzed distal cholangiocarcinoma as periampullary tumors combined with pancreatic head cancer. Therefore, the aim of the present study was to investigate the application of the NLR, the PNI and the GPS in evaluating risk factors for postoperative morbidity in patients with distal cholangiocellular or ampullary carcinoma. Eighty-four patients who underwent pancreaticoduodenectomy (PD) for distal cholangiocellular or ampullary carcinoma at the Department of Surgery in Kitasato University Hospital between 2008 and 2016 were enrolled. Associations between perioperative characteristics (NLR, PNI and GPS) and postoperative complications (Clavien-Dindo classification grade III or higher) were retrospectively analyzed. In the univariate analysis, neutrophil and lymphocyte counts, body mass index (BMI) and the NLR were associated with postoperative complications (P<0.05). In the multivariate analysis, BMI [>23.0 kg/m2; odds ratio (OR): 3.80, 95.0% confidence interval (CI): 1.35–11.83; P=0.011] and the NLR (>2.0; OR: 6.77, 95.0% CI: 2.44–21.13; P<0.001) were independent risk factors for postoperative complications. BMI and the NLR are valuable predictors of postoperative morbidity following PD in patients with distal cholangiocarcinoma. It would be beneficial to determine treatment strategies for distal cholangiocarcinoma based on the NLR to reduce postoperative complications.

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“…Although there have been advances in surgical approaches and perioperative care related to colon cancer, major postoperative complications remain an important cause of morbidity and mortality. Several studies conducted in recent years have found sarcopenia to be associated with short-and long-term adverse outcomes [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia is associated with increased severe postoperative complications after colon cancer surgery

et al. 2021

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Introduction: Studies have shown that sarcopenia is associated with poor outcomes in patients with gastrointestinal cancer undergoing surgery. We aimed to investigate the relationship between postoperative complications of sarcopenic patients who had been operated on for colon cancer and the effects on short-term mortality. Material and methods: In this study, patients who had undergone colon cancer surgery between January 2013 and December 2018 were collected retrospectively. Sarcopenia was diagnosed by the skeletal muscle index (SMI) derived from a preoperative computed tomography scan. Multiple logistic regression analysis was performed to determine whether sarcopenia is associated with postoperative major complications (POMC). Results: The study included 160 patients with a mean age of 62.4 ±12.6 years. Clavien-Dindo grade 1-2 (minor) complications were not significantly different between the groups (p = 0.896). However, grade ≥ 3 (major) complications were detected in 13 (17.8%) patients in the sarcopenic group (SG) and in 5 patients in the non-sarcopenic group (NSG) (5.7%) (p = 0.016). Length of intensive care unit (ICU) stay was longer in SG (p = 0.002) and there was no difference between 1-month and 6-month mortality rates (p = 0.273 and p = 0.402, respectively). According to univariate analyses, sarcopenia and age over 65 years were related to POMC. In multivariate analyses, sarcopenia (odds ratio = 3.039; 95% confidence interval 1.008-9.174; p = 0.048) and advanced age (odds ratio = 3.246; 95% confidence interval 1.078-9.803; p = 0.036) were found to be independent risk factors for POMC. Conclusions: This study showed that while sarcopenia is a risk factor for POMC, sarcopenia also prolongs the duration of ICU stay. Also sarcopenia has no effect on short-term mortality.

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Effect of sarcopenia on the outcomes after pancreaticoduodenectomy for distal cholangiocarcinoma

Abstract: Our findings suggested an association between pre-operative sarcopenia and poor long-term oncological outcomes after PD for DCC.

Cited by 19 publications

References 30 publications

Impact of preoperative body compositions on survival following resection of biliary tract cancer

Impact of preoperative body compositions on survival following resection of biliary tract cancer

Neutrophil‑to‑lymphocyte ratio as a predictor of postoperative morbidity in patients with distal cholangiocarcinoma

Sarcopenia is associated with increased severe postoperative complications after colon cancer surgery

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