Sato Tsutomu, Aoyama Toru, Hayashi Tsutomu, Segami Kenki, Kawabe Taiichi, Fujikawa Hirohito, Yamada Takanobu, Yamamoto Naoto, Oshima Takashi, Rino Yasushi, Masuda Munetaka, Ogata Takashi, Cho Haruhiko, Yoshikawa Takaki
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.
Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
Gastric Cancer. 2016 Jul;19(3):1008-15. doi: 10.1007/s10120-015-0554-4. Epub 2015 Oct 14.
Sarcopenia is a decrease in both muscle mass and strength. It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery. This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery.
A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined. Patients with performance status 3 or 4 were excluded. Preoperative lean body mass (LBM) was evaluated by bioelectrical impedance analysis and expressed as LBM index. Preoperative muscle function was measured by hand grip strength (HGS). The cutoff values were the gender-specific lowest 20 %. Grade 2 or higher morbidities, as retrospectively evaluated by the Clavien-Dindo classification, were obtained from the patient record. The risk factors for morbidity were examined by univariate and multivariate analyses.
Morbidity was observed in 39 patients (13.3 %), including 7 with pancreatic leakage, 12 with anastomotic leakage, and 4 with intraabdominal abscesses, but no mortality was observed. The univariate analysis showed that male gender, total gastrectomy, splenectomy, and a low HGS were significant risk factors for morbidity. A low LBM was not a significant risk factor. A low HGS, male gender, and total gastrectomy remained significant in the multivariate analysis.
A low hand grip strength was a significant risk factor for morbidity after gastric cancer surgery. The importance of the hand grip strength as a risk factor should be examined in future prospective studies.
肌肉减少症是肌肉质量和力量的下降。目前尚不清楚肌肉减少症是否与胃癌手术后的发病率相关。本研究评估了肌肉减少症对胃癌手术发病率的影响。
回顾性研究了2011年5月至2013年6月期间接受根治性手术的293例胃癌患者。排除体能状态为3或4级的患者。通过生物电阻抗分析评估术前瘦体重（LBM），并表示为LBM指数。通过握力（HGS）测量术前肌肉功能。临界值为按性别划分的最低20%。通过Clavien-Dindo分类法回顾性评估的2级或更高等级的并发症从患者记录中获取。通过单因素和多因素分析检查并发症的危险因素。
39例患者（13.3%）出现并发症，包括7例胰漏、12例吻合口漏和4例腹腔内脓肿，但未观察到死亡病例。单因素分析显示，男性、全胃切除术、脾切除术和低HGS是并发症的显著危险因素。低LBM不是显著危险因素。在多因素分析中，低HGS、男性和全胃切除术仍然显著。
低握力是胃癌手术后并发症的显著危险因素。握力作为危险因素的重要性应在未来的前瞻性研究中进行检验。
