Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

Abstract

Introduction Sarcopenia is highly prevalent in patients with gastrointestinal malignancies, including gastric cancer, but there is a lack of adequate data from Western populations. Methods Computed tomography scans of 138 Caucasian patients subject to stomach resections due to gastric adenocarcinoma between 2012 and 2015 were reviewed to evaluate the impact of sarcopenia. The definition of sarcopenia was based on the lumbar skeletal muscle index (SMI) using cut‐off values formulated by the international consensus definitions of sarcopenia (SMI <52.4 cm2/m2 for men and <38.5 cm2/m2 for women). Results Sixty (43%) of 138 patients were sarcopenic. Sarcopenia was associated with postoperative morbidity (43% vs 23%; P = .011), major postoperative complications (Clavien‐Dindo ≥3a; 36% vs 21%; P = .035), and reoperations (23% vs 9%; P = .020). Patients with sarcopenia also had prolonged postoperative hospital stay (8.0 vs 6.5 days; P = .010). The overall median survival of patients with sarcopenia was significantly lower than those with normal skeletal muscles (11.0 vs 36.7 months; P = .005) and sarcopenia remained an independent prognostic factor with an odds ratio of 1.94 (95% confidence interval, 1.08 to 3.48; P = .026). Conclusion Sarcopenia, defined by SMI, is associated with an increased risk of postoperative morbidity and impaired long‐term survival.

Sarcopenia: Unraveling the network

“…We highly appreciate the interest that Hu Qiang and colleagues have shown in this letter 1 . Diminished muscle mass and strength defining sarcopenia have been increasingly reported as important components of a network of elements influencing perioperative outcomes in cancer surgery.…”

“…We highly appreciate the interest that Hu Qiang and colleagues have shown in this letter. 1 Splenectomy and resection of the distal pancreas are usually associated with higher morbidity rates and are not recommended routinely in patients with gastric cancer due to the lack of clinical benefits. 3,4 However, there are many other patient and treatmentrelated parameters that could affect the safety and efficacy of treatment.…”

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We highly appreciate the interest that Hu Qiang and colleagues have shown in this letter. 1 Diminished muscle mass and strength defining sarcopenia have been increasingly reported as important components of a network of elements influencing perioperative outcomes in cancer surgery. Diagnosis of sarcopenia, as reasonably expected, was associated with increased postoperative complications, length of hospital stay, and mortality in various clinical settings.

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Sarcopenia associated with gastric cancer

“…We highly appreciate the interest that Binay Safer and colleagues have shown in our article . Sarcopenia has been increasingly recognized as an important clinical entity influencing various aspects of care among patients with malignant tumors.…”

Comment on “Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach”

“…We have read with interest the article published by Sierzega et al 1 Although we believe it is a very interesting topic and plays an important role in guiding us to evaluate the postoperative gastric cancer, we would like to offer the following points for your consideration. Second, the number of splenectomy (11 vs 5) and pancreaticosplenectomy (4 vs 0) in sarcopenia group was more than that in no sarcopenia group, and the difference was statistically significant.…”