Preoperative sarcopenia is a negative predictor for enhanced postoperative recovery after pancreaticoduodenectomy

Nauheim, David; Hackbart, Hannah; Papai, Emily; Moskal, David; Yeo, Charles J.; Lavu, Harish

doi:10.1007/s00423-022-02558-w

Cited by 8 publications

(5 citation statements)

References 47 publications

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“…Other studies have identified sarcopenia as a risk factor for increased complication rates (OR 4.3; 95%CI 2.2-8.5, p < 0.01) and longer LOS (p < 0.05), and on multivariate analysis have identified SMA, a low BMI, and male gender as predictors of increased LOS [35].…”

Section: Discussionmentioning

confidence: 95%

“…In a retrospective review of 333 patients undergoing PD, patient demographics revealed a heavier population with a BMI reported as 27.9 ± 5.5 kg/m 2 in the nonsarcopenic cohort and 25.9 ± 4.4 kg/m 2 in those with sarcopenia [35], compared to a BMI of 25.9 ± 4.0 kg/m 2 in our non-sarcopenic group and 22.4 ± 3.5 kg/m 2 in our sarcopenic group. In contrast to this study, we identified a higher complication rate in those with a high BMI (p = 0.039), but this data is limited due to a lack of control of potentially confounding variables.…”

Section: Discussionmentioning

confidence: 99%

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Standard Nutritional Assessment Tools Are Unable to Predict Loss of Muscle Mass in Patients Due to Undergo Pancreatico-Duodenectomy: Highlighting the Need for Detailed Nutritional Assessment

Phillips,

Robertson,

Bennett-Eastley

et al. 2024

Nutrients

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Background and Methods: Pancreatico-duodenectomy (PD) carries significant morbidity and mortality, with very few modifiable risk factors. Radiological evidence of sarcopenia is associated with poor outcomes. This retrospective study aimed to analyse the relationship between easy-to-use bedside nutritional assessment techniques and radiological markers of muscle loss to identify those patients most likely to benefit from prehabilitation. Results: Data were available in 184 consecutive patients undergoing PD. Malnutrition was present in 33–71%, and 48% had a high visceral fat-to-skeletal muscle ratio, suggestive of sarcopenic obesity (SO). Surgical risk was higher in patients with obesity (OR 1.07, 95%CI 1.01–1.14, p = 0.031), and length of stay was 5 days longer in those with SO (p = 0.006). There was no correlation between skeletal muscle and malnutrition using percentage weight loss or the malnutrition universal screening tool (MUST), but a weak correlation between the highest hand grip strength (HGS; 0.468, p < 0.001) and the Global Leadership in Malnutrition (GLIM) criteria (−0.379, p < 0.001). Conclusions: Nutritional assessment tools give widely variable results. Further research is needed to identify patients at significant nutritional risk prior to PD. In the meantime, those with malnutrition (according to the GLIM criteria), obesity or low HGS should be referred to prehabilitation.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Standard Nutritional Assessment Tools Are Unable to Predict Loss of Muscle Mass in Patients Due to Undergo Pancreatico-Duodenectomy: Highlighting the Need for Detailed Nutritional Assessment

Phillips,

Robertson,

Bennett-Eastley

et al. 2024

Nutrients

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“…Four studies reported the overall rate of postoperative complications, which was statistically significant after combining the effects across studies (OR = 3.42, 95%CI: 1.95-5.99, P < 0.0001)[ 7 , 14 , 18 , 21 ] (Figure 3A ). Nine studies reported major postoperative complications (C-D ≥ III), yielding statistically significant combined effects (OR = 1.41, 95%CI: 1.04-1.90, P = 0.03)[ 5 - 7 , 12 , 15 , 16 , 19 , 20 , 22 ] (Figure 3B ).…”

Section: Resultsmentioning

confidence: 99%

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

Zhang,

Ma,

et al. 2024

World J Gastrointest Surg

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BACKGROUND Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength, as well as a decline in functional ability, which is associated with malnutrition, hormonal changes, chronic inflammation, disturbance of intestinal flora, and exercise quality. Pancreatoduodenectomy is a commonly employed clinical intervention for conditions such as pancreatic head cancer, ampulla of Vater cancer, and cholangiocarcinoma, among others, with a notably high rate of postoperative complications. Sarcopenia is frequent in patients undergoing pancreatoduodenectomy. However, data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy (PD) are both limited and inconsistent. AIM To assess the influence of sarcopenia on outcomes in patients undergoing PD. METHODS The PubMed, Cochrane Library, Web of Science, and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD. Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria. Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted. Forest and funnel plots were used, respectively, to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias. RESULTS Sixteen studies encompassing 2381 patients were included in the meta-analysis. The patients in the sarcopenia group (n = 833) had higher overall postoperative complication rates [odds ratio (OR) = 3.42, 95% confidence interval (CI): 1.95-5.99, P < 0.0001], higher Clavien-Dindo class ≥ III major complication rates (OR = 1.41, 95%CI: 1.04-1.90, P = 0.03), higher bacteremia rates (OR = 4.46, 95%CI: 1.42-13.98, P = 0.01), higher pneumonia rates (OR = 2.10, 95%CI: 1.34-3.27, P = 0.001), higher pancreatic fistula rates (OR = 1.42, 95%CI: 1.12-1.79, P = 0.003), longer hospital stays (OR = 2.86, 95%CI: 0.44-5.28, P = 0.02), higher mortality rates (OR = 3.17, 95%CI: 1.55-6.50, P = 0.002), and worse overall survival (hazard ratio = 2.81, 95%CI: 1.45-5.45, P = 0.002) than those in the non-sarcopenia group (n = 1548). However, no significant inter-group differences were observed regarding wound infections, urinary tract infections, biliary fistulas, or postoperative digestive bleeding. CONCLUSION Sarcopenia is a common comorbidity in patients undergoing PD. Patients with preoperative sarcopenia have increased rates of complications and mortality, in addition to a poorer overall survival rate and longer hospital stays after PD.

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“…Low ALB indicates impaired immune function, and the probability of incision infection after PD is increased. 4,5 Some studies have also shown that hypoalbuminemia can cause anastomotic edema and increase the probability of postoperative leakage. 6 Therefore, the level of ALB is closely related to the complications of PD, which needs our attention.…”

Section: An Assessment Of Perioperative Outcomes For Open Laparoscopi...mentioning

confidence: 99%

An assessment of perioperative outcomes for open, laparoscopic, and robot‐assisted pancreaticoduodenectomy

Yang¹,

Zhu

2022

Journal of Surgical Oncology

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Preoperative sarcopenia is a negative predictor for enhanced postoperative recovery after pancreaticoduodenectomy

Cited by 8 publications

References 47 publications

Standard Nutritional Assessment Tools Are Unable to Predict Loss of Muscle Mass in Patients Due to Undergo Pancreatico-Duodenectomy: Highlighting the Need for Detailed Nutritional Assessment

Standard Nutritional Assessment Tools Are Unable to Predict Loss of Muscle Mass in Patients Due to Undergo Pancreatico-Duodenectomy: Highlighting the Need for Detailed Nutritional Assessment

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

An assessment of perioperative outcomes for open, laparoscopic, and robot‐assisted pancreaticoduodenectomy

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