Pre‐operative low muscle mass is associated with major complications and lower recurrence‐free survival after gastric cancer surgery

Abstract

Background: Low muscle mass (LMM) has been associated with post-operative morbidity. This study aimed to examine the relationship between pre-operative LMM and major postoperative complications and survival in patients undergoing curative resection for gastric cancer. Methods: A single-centre retrospective cohort study was conducted on consecutive patients who underwent surgical resection for gastric adenocarcinoma between 2008 and 2018. Patient demographics, radiological parameters, pathological data and complications were recorded. Skeletal muscle index was calculated using OsiriX software by manually measuring the cross-sectional skeletal muscle area at the third lumbar vertebra and correcting to the patient's height. Univariate and multivariate analyses were used to identify the risk factors associated with the outcomes. Results: A total of 62 patients (36 males, mean age 68.3 ± 1.5 years) met the inclusion criteria. Twenty-six (41.9%) patients had LMM pre-operatively. Demographic data in the non-LMM and LMM groups were equally matched except for body mass index (27.6 ± 0.8 kg/m 2 versus 24.3 ± 1.1 kg/m 2 ; P = 0.012) and serum albumin (36.7 ± 0.7 g/L versus 33.8 ± 1.0 g/L; P = 0.017), which were higher in the non-LMM. LMM was associated with higher incidence of total (35.5% versus 64.5%; P = 0.006), minor (40% versus 60%; P = 0.030), major (9.1% versus 90.9%; P = 0.004) post-operative complications and decreased recurrence-free survival (hazard ratio 2.29; 95% confidence interval 1.10-4.77; P = 0.027). Conclusion: LMM is a significant independent risk factor for major post-operative complications and recurrence-free survival after gastrectomy. Pre-operative identification of LMM could be a useful tool for prognostication and may identify a group suitable for prehabilitation.

Impact of Preoperative Skeletal Muscle Mass on the Outcomes and Recurrence After Total Gastrectomy in Patients With Gastric Cancer

“…To the best of our knowledge, only a few published studies suggest greater risk for recurrence in patients with low muscle mass before gastric surgery for gastric cancer. 23,24 Skeletal muscle in nonobese individuals is the largest human organ and has been identified as a secretory organ. 25 Bioactive proteins or myokines secreted from skeletal muscle cells influence the onset and course of disease through their endocrine function, as they interplay with weight regulation, innate and adaptive immune system, insulin sensitivity, altered pharmacokinetics of anticancer drugs, protein status, and tumor growth.…”

“…We defined a poor outcome as death at the end of follow-up period. To the best of our knowledge, only a few published studies suggest greater risk for recurrence in patients with low muscle mass before gastric surgery for gastric cancer 23,24…”

CT‐determined low skeletal muscle mass predicts worse overall survival of gastric cancer in patients with cachexia

“…Later, another meta‐analysis by Rinninella, E et al 13 indicated that CT‐determined low SMM predicted a significantly worse OS of GC. A recent single‐center retrospective cohort study also reported that low SMM was associated with increased major complications and poor survival in GC 14 . However, controversies still existed, and several clinical studies indicated that CT‐determined low SMM was not significantly associated with OS of GC recently 15–18 .…”

“…A recent single‐center retrospective cohort study also reported that low SMM was associated with increased major complications and poor survival in GC. 14 However, controversies still existed, and several clinical studies indicated that CT‐determined low SMM was not significantly associated with OS of GC recently. 15 , 16 , 17 , 18 The meta‐analyses and clinical studies mentioned above have not conducted a subgroup analysis of potential confounding variables for the associations between CT‐determined low SMM and OS of GC, which might lead to inconsistent results.…”

Desnutrição e Baixa Massa Muscular em Pacientes com Câncer Gastrointestinal Submetidos à Cirurgia: Existe Associação com a Localização do Tumor?

“…Entretanto, tal condição pode estar presente em indivíduos com doenças crônicas, como o câncer, denominada como sarcopenia secundária 8,9 . De fato, a baixa massa muscular esquelética e, mais recentemente, a sarcopenia vêm sendo exploradas como condições associadas ao maior risco de complicações pós-operatórias e menor sobrevida em pacientes com câncer submetidos a cirurgias do trato gastrointestinal [10][11][12][13][14][15][16] .…”