Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy

Abstract

Background Skeletal muscle loss is associated with physical disability, nosocomial infections, postoperative complications, and decreased survival. Preventing the loss of skeletal muscle mass after gastrectomy may lead to improved outcomes. The aims of this study were to assess changes in skeletal muscle mass after total gastrectomy (TG) and to clarify the clinical factors affecting significant loss of skeletal muscle after TG. Patients and methods One hundred and two patients undergoing TG for primary gastric cancer underwent abdominal computed tomography before and 1 year after TG to precisely quantify postoperative changes in skeletal muscle and adipose tissue. Univariate and multivariate logistic regression analyses identified clinical factors contributing to significant loss of skeletal muscle after TG.Results At 1 year after TG, the mass of both skeletal muscle and adipose tissue was reduced by 6.20 ± 6.80 and 65.8 ± 36.1 % of the preoperative values, respectively, and 26 patients (25.5 %) showed a significant loss of skeletal muscle of more than 10 %. Adjuvant chemotherapy with S-1 for C6 months (hazard ratio 26.61, 95 % confidence interval, 3.487-203.1) was identified as the single independent risk factor for a significant loss of skeletal muscle. Conclusions Skeletal muscle loss was exacerbated by extended adjuvant chemotherapy after TG. Further research should identify appropriate nutritional interventions for maintaining skeletal muscle mass and leading to improved outcomes.

Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder

“…Previous studies have reported on changes in skeletal muscle mass during chemotherapy in patients with unresectable colorectal cancer [16] and advanced lung cancer [19], changes in skeletal muscle and adipose tissue in gastric cancer patients undergoing total gastrectomy [18] and changes in muscle, fat and bone mass during androgen blockade in prostate cancer patients [17, 26]. …”

“…The PNI was calculated using the following formula: 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm 3 ) [18]. The CONUT score was determined on the basis of the serum albumin, peripheral lymphocyte count and the T-cholesterol, as previously described (Table 1) [22].…”

Loss of skeletal muscle mass after curative gastrectomy is a poor prognostic factor

“…In gastric cancer, preoperative sarcopenia has been shown to be a predictive marker of postoperative complications and poor prognosis (9). In two previous studies, a 6.2% loss of skeletal muscle was observed after total gastrectomy (10), and adjuvant chemotherapy with S-1 was identified as an independent risk factor for significant loss of skeletal muscle (11). Moreover, reductions of lean body muscle mass after gastrectomy has been reported to prevent the continuation of adjuvant chemotherapy (12).…”

More than 6 months of postoperative adjuvant chemotherapy results in loss of skeletal muscle: a challenge to the current standard of care

“…The loss in muscle mass actually had no impact on survival in the Osaka study [3]. However, patients who received S-1 monotherapy for more than 6 months should have benefited from adherence to the treatment, given that the standard of care is to deliver S-1 for 12 months.…”

“…These findings prompted physicians to consider early postoperative enteral nutrition to minimize the inevitable weight loss following gastrectomy, and several trials to prove the benefit of such approach are currently ongoing. In the meantime, another active group of investigators in Osaka reported in a recent article published in Gastric Cancer that a group of patients who tolerated adjuvant S-1 monotherapy for 6 months or more after receiving total gastrectomy carry a significant risk for greater than 10 % loss of skeletal muscle when compared with those who failed to do so [3]. In contrast, the duration of chemotherapy did not affect the degree of loss in total body weight or fat mass.…”