Impact of preoperative muscle quality on postoperative severe complications after radical gastrectomy for gastric cancer patients. Issue 4 (13th March 2021)

• Record Type: Journal Article
• Authors: Matsui, Ryota; Inaki, Noriyuki; Tsuji, Toshikatsu
• Is Part Of: Annals of gastroenterological surgery. Volume 5:Issue 4(2021)
• Page Start: 510
• Page End: 518
• Publication Date: 2021-03-13
• Subjects: gastric cancer -- intramuscular adipose tissue content -- muscle quality -- postoperative severe complication; Digestive organs -- Surgery -- Periodicals; 617.43
• DOI: 10.1002/ags3.12452
• Languages: English
• ISSNs: 2475-0328

Abstract

Abstract: Background: Preoperative sarcopenia is an important risk factor for postoperative complications in patients with gastric cancer. However, the relationship between muscle quality and postoperative complications in patients with gastric cancer is inadequately studied. Therefore, we investigated the impact of preoperative muscle quality on severe postoperative complications after radical gastrectomy. Methods: A total of 840 patients who underwent radical gastrectomy for p‐stages I–III primary gastric cancer between April 2008 and June 2018 with preoperative computed tomography (CT) scans and body composition analysis were included. We measured intramuscular adipose tissue content (IMAC) as an indicator of muscle quality. A higher IMAC signified a poorer quality. All statistical analyses were performed with EZR, and a P ‐value < 0.05 was considered statistically significant. Results: The low‐IMAC and high‐IMAC groups had 422 (50.2%) and 418 (49.8%) patients, respectively. The latter were older ( P < 0.001), had higher body mass index (BMI) ( P < 0.001), and higher rates of chronic kidney disease (CKD) ( P = 0.002) and diabetes ( P < 0.001). They had lower skeletal muscle indexes (SMI) ( P = 0.011) and higher visceral fat areas (VFA) ( P < 0.001). They also experienced more intraoperative blood loss ( P < 0.001) and greater complications ( P = 0.016). Multivariate analysis showed that high‐IMAC was an independent risk factor for severe complications (odds ratio: 2.260, 95% confidence interval: 1.220‐4.190, P = 0.010). Conclusions: Poor preoperative muscle quality is an independent risk factor for severe postoperative complications after radical gastrectomy in patients with gastric cancer. Abstract : This study highlights the relationship between preoperative low muscle quality and postoperative severe complications after radical gastrectomy. As muscle quality is thought to decrease in correlation to age, with the increasing rates of elderly patients, there is a need to develop and refine tools to assess muscle quality.