Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Department of Surgery, NTT West Osaka Hospital, 2-6-40 Karasugatsuji, Tennoji-ku, Osaka, 543-8922, Japan.
Gastric Cancer. 2017 Sep;20(5):913-918. doi: 10.1007/s10120-016-0683-4. Epub 2016 Dec 28.
We established a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer. Twenty-two gastric cancer patients aged 65 years or older with a diagnosis of sarcopenia according to the algorithm proposed by the European Working Group on Sarcopenia in Older People received our preoperative program. The median duration of the program participation was 16 days. Total calorie and protein intakes were significantly higher after the program than before [29.4 ± 6.9 kcal/kg ideal body weight (IBW) vs 27.3 ± 5.6 kcal/kg IBW, p = 0.049, and 1.3 ± 0.4 g/kg IBW vs 1.1 ± 0.3 g/kg IBW, p = 0.0019, respectively]. Handgrip strength significantly increased after the program (21.2 ± 5.2 kg vs 20.0 ± 5.3 kg, p = 0.022). Likewise, gait speed and skeletal muscle mass index increased, although the differences did not reach statistical significance. Four patients became nonsarcopenic after the program. Postoperative complications were observed in three patients (13.6%); however, none of these complications were severe (Clavien-Dindo grade III or lower). A preoperative exercise and nutritional support program has the potential to reduce sarcopenia and improve postoperative outcome in elderly sarcopenic patients with gastric cancer.
我们为老年胃癌合并肌少症患者制定了术前运动和营养支持方案。22 名年龄在 65 岁及以上、根据欧洲老年人肌少症工作组提出的算法诊断为肌少症的胃癌患者接受了我们的术前方案。方案参与的中位数时间为 16 天。与方案前相比，总热量和蛋白质摄入量显著增加[29.4±6.9 千卡/公斤理想体重（IBW）比 27.3±5.6 千卡/公斤 IBW，p=0.049，1.3±0.4 克/公斤 IBW 比 1.1±0.3 克/公斤 IBW，p=0.0019]。握力在方案后显著增加（21.2±5.2 公斤比 20.0±5.3 公斤，p=0.022）。同样，步速和骨骼肌质量指数增加，尽管差异没有达到统计学意义。4 名患者在方案后不再患有肌少症。术后并发症在 3 名患者中观察到（13.6%）；然而，这些并发症均不严重（Clavien-Dindo 分级 III 级或以下）。术前运动和营养支持方案有可能减少老年胃癌合并肌少症患者的肌少症并改善术后结局。
