Survival Impact of Postoperative Skeletal Muscle Loss in Gastric Cancer Patients Who Underwent Gastrectomy

Kuwada, Kazuya; Kikuchi, Shinichi; Kuroda, Shinji; Yoshida, Ryuichi; Takagi, Kosei; Noma, Kazuhiro; Nishizaki, Masahiko; Kagawa, Shunsuke; Umeda, Yuzo; Fujiwara, Toshiyoshi

doi:10.21873/anticanres.16153

Cited by 10 publications

(6 citation statements)

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“…A 15.0% weight loss after TG versus a 10.8% weight loss after PG is considered clinically significant, with a non-negligible impact on daily life, and impaired nutrition status may lead to subsequent long-term risks of other morbidity associated with sarcopenia. 25 A randomized controlled trial, in which the primary endpoints are changes in hemoglobin levels and the vitamin B12 supplement quantity after PG and TG, is currently underway (KLASS-05 trial) in South Korea. 26 Furthermore, several retrospective studies show that PG is superior to TG in maintaining body weight and preserving QOL.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, data on body composition was unavailable this time, weight loss is closely correlated with decreased muscle mass (i.e., sarcopenia). A 15.0% weight loss after TG versus a 10.8% weight loss after PG is considered clinically significant, with a non‐negligible impact on daily life, and impaired nutrition status may lead to subsequent long‐term risks of other morbidity associated with sarcopenia 25 …”

Section: Discussionmentioning

confidence: 99%

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A multi‐institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602)

Kanda,

Tanaka,

Misawa

et al. 2024

World j. surg.

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BackgroundProximal gastrectomy (PG) has become an increasingly preferred procedure for treating early cancer in the upper third of the stomach. However, advantages of PG in postoperative quality of life (QOL) over total gastrectomy (TG) has not fully proven.MethodsWe conducted a multi‐institutional prospective observational study (CCOG1602) of patients who undergo TG or PG for cStage I gastric cancer. We used the PGSAS‐37 and EORTC‐QLQ‐C30 to evaluate the changes in body weight and QOL over a 3‐year postoperative period. The primary endpoint was the weight loss rate 3 years after surgery.ResultsWe enrolled 109 patients from 18 institutions and selected 65 and 19 patients for inclusion in the TG and PG groups, respectively. Mean postoperative weight loss rates were 16.0% and 11.7% for the TG and PG groups, respectively (p = 0.056, Cohen's d 0.656) during postoperative year 1% and 15.0% and 10.8% for TG and PG (p = 0.068, Cohen's d 0.543), respectively, during postoperative year 3, indicating that the PG group achieved a better trend with a moderate effect size. According to the PGSAS‐37, the PG group experienced a better trend in the indigestion subscale (p < 0.001, Cohen's d −1.085) and total symptom score (p = 0.050, Cohen's d −0.59) during postoperative year 3 compared with the TG group. In contrast, the EORTC‐QLQ‐C30 detected no difference between the groups at any time point during 3‐year postoperative period.ConclusionsThis prospective study demonstrates that PG tended to be more favorable compared with TG with respect to postoperative weight loss and QOL, particularly regarding indigestion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A multi‐institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602)

Kanda,

Tanaka,

Misawa

et al. 2024

World j. surg.

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“…After surgical treatment for GC, sarcopenia, characterized by progressive and generalized loss of skeletal muscle mass and strength [ 21 ], is likely to occur due to surgical stress and nutritional disorders. Postoperative sarcopenia has been reported to be associated with postoperative complications and to result in an unfavorable prognosis after gastrectomy [ 22 ]. The progression of sarcopenia may lead to a loss of swallowing-related muscles and eventually to dysphagia, resulting in aspiration pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for death from other diseases after curative gastrectomy and lymph node dissection for gastric cancer

Hanyu,

Ichikawa,

Kano

et al. 2024

BMC Surg

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Background Recent advances in treatment are expected to bring a cure to more patients with gastric cancer (GC). Focusing on the risk of death from other diseases (DOD) has become a crucial issue in patients cured of GC. The aim of this study was to elucidate the risk factors for DOD in patients who underwent curative gastrectomy with lymph node dissection for GC. Methods We enrolled 810 patients who underwent curative gastrectomy with lymph node dissection for GC from January 1990 to December 2014 and had no recurrence or death of GC until December 2019. We investigated the risk factors for DOD defined as death excluding death from a malignant neoplasm, accident, or suicide after gastrectomy, focusing on the perioperative characteristics at gastrectomy. Results Among 315 deaths from any cause, 210 died from diseases other than malignancy, accidents and suicide. The leading cause of DOD was pneumonia in 54 patients (25.7%). The actual survival period in 167 patients (79.5%) with DOD was shorter than their estimated life expectancy at gastrectomy. Multivariate analysis revealed that a high Charlson Comorbidity Index score (score 1–2: hazard ratio [HR] 2.192, 95% confidence interval [CI] 1.713–2.804, P < 0.001 and score ≥ 3: HR 4.813, 95% CI 3.022–7.668, P < 0.001), total gastrectomy (HR 1.620, 95% CI 1.195–2.197, P = 0.002) and the presence of postoperative complications (HR 1.402, 95% CI 1.024–1.919, P = 0.035) were significant independent risk factors for DOD after gastrectomy for GC, in addition to age of 70 years or higher, performance status of one or higher and body mass index less than 22.0 at gastrectomy. Conclusions Pneumonia is a leading cause of DOD after curative gastrectomy and lymph node dissection for GC. Paying attention to comorbidities, minimizing the choice of total gastrectomy and avoiding postoperative complications are essential to maintain the long-term prognosis after gastrectomy.

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“…Enhanced recovery of patient care pathways (ERAS) is becoming the standard of care for surgery (31). According to the ERAS 2019 recommendations, avoidance of postoperative nasogastric tubes, early diet, early mobilization, and near-zero fluid balance to avoid excessive fluid administration are encouraged to improve patient outcomes (32,33). A multi-disciplinary team approach for perioperative management, such as nutritional and physical therapy, is becoming increasingly important as the number of patients with sarcopenia increases with population aging.…”

Section: Discussionmentioning

confidence: 99%

Skeletal Muscle Mass Index Reduction Rate as a Prognostic Indicator for Patients Undergoing Pancreatectomy for Pancreatic Cancer

MITA,

MAEDA,

TSUJITA

et al. 2024

CDP

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Background/Aim: There have been many studies on skeletal muscle depletion before surgery, and skeletal muscle depletion is a known risk factor for poor prognosis. However, reports on the association between changes in skeletal muscle mass and prognosis after surgery for pancreatic cancer are very few. Patients and Methods: The data of 137 patients who underwent pancreatectomy for pancreatic cancer between 2005 and 2022 were reviewed. Muscle areas were measured at the third lumbar vertebral level, and skeletal muscle mass index (SMI) reduction rates were calculated. Patients were divided into two groups using receiver operating characteristic (ROC) curve analysis based on the SMI reduction rate with a cutoff of 14% reduction rate. The clinicopathological factors, overall survival (OS), and recurrence-free survival (RFS) were compared between the two groups. Survival rates were analyzed both univariately and multivariately to clarify the factors associated with poor prognosis after pancreatectomy. Results: A total of 102 patients met the inclusion criteria. SMI reduction rate ≥14% significantly correlated with advanced age and higher incidence of postoperative complications. In the multivariate Cox regression analysis, preoperative prognostic nutritional index (PNI) <40 and SMI reduction rate ≥14% were significantly associated with poor OS. Tumor size ≥3.0 cm, preoperative neutrophile-lymphocyte ratio ≥3.0, and SMI reduction rate ≥14% were significantly associated with poor RFS. Conclusion: The rate of skeletal muscle mass reduction after pancreatic surgery is an independent prognostic factor for survival in patients with pancreatic cancer.

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Survival Impact of Postoperative Skeletal Muscle Loss in Gastric Cancer Patients Who Underwent Gastrectomy

Cited by 10 publications

References 0 publications

A multi‐institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602)

A multi‐institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602)

Risk factors for death from other diseases after curative gastrectomy and lymph node dissection for gastric cancer

Skeletal Muscle Mass Index Reduction Rate as a Prognostic Indicator for Patients Undergoing Pancreatectomy for Pancreatic Cancer

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