Adverse Effects of Low Preoperative Skeletal Muscle Mass in Patients Undergoing Gastrectomy for Gastric Cancer

• Published in: Annals of surgical oncology Vol. 24; no. 9; pp. 2712 - 2719
• Main Authors: Sakurai, Katsunobu, Kubo, Naoshi, Tamura, Tatsuro, Toyokawa, Takahiro, Amano, Ryosuke, Tanaka, Hiroaki, Muguruma, Kazuya, Yashiro, Masakazu, Maeda, Kiyoshi, Hirakawa, Kosei, Ohira, Masaichi
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-09-2017; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Body Composition; Cause of Death; Computed tomography; Female; Gastrectomy; Gastric cancer; Gastrointestinal Oncology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Muscle, Skeletal - diagnostic imaging; Muscle, Skeletal - pathology; Musculoskeletal system; Neoplasm Staging; Nutritional Status; Oncology; Preoperative Period; Sarcopenia; Sarcopenia - complications; Sarcopenia - therapy; Side effects; Skeletal muscle; Stomach Neoplasms - complications; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Survival; Survival Rate; Time Factors; Tomography, X-Ray Computed; Gastric Cancer; Overall Survival Rate; Prognostic Nutritional Index; Overall Survival; Skeletal Muscle Mass
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-017-5875-6

Objective
The aim of this study was to determine the impact of preoperative skeletal muscle mass on short- and long-term outcomes of patients with gastric cancer (GC) who undergo gastrectomy.
Methods
A total of 569 patients subjected to gastrectomy for GC at our institution between January 2007 and December 2013 were reviewed and skeletal muscle index (SMI) was measured via cross-sectional, image-based muscle assessment. Computed tomography (CT) and the volume analyzer SYNAPSE VINCENT were required. Patients were divided into two groups, with the first quartile serving as the cut-point for both men and women. Clinicopathologic features and short- and long-term outcomes were compared.
Results
In multivariate analysis, SMI emerged as an independent predictor of 5 year overall survival (OS) and cancer-specific survival (CSS) in patients with GC. In subgroup analysis, by stage, patients with stage I disease and low (vs. high) SMI demonstrated significantly worse 5 year OS. The incidence of postoperative complications did not differ significantly by group.
Conclusions
Preoperative SMI, measured in cross-section using CT, is a useful nutritional determinant that may predict OS and CSS in patients with GC who undergo gastrectomy. In our view, nutritional support for sarcopenic patients with stage I GC, aimed at retaining or adding skeletal muscle mass, may improve survival. Our analysis showed no relationship between preoperative SMI and postoperative complications.