Jones Keaton, Gordon-Weeks Alex, Coleman Claire, Silva Michael
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
CRUK Centre for Radiation Oncology, Radiobiology Research Institute, Department of Oncology, University of Oxford, Churchill Hospital, Roosevelt Drive, Oxford, OX3 7LE, UK.
World J Surg. 2017 Sep;41(9):2266-2279. doi: 10.1007/s00268-017-3999-2.
Individualised risk prediction is crucial if targeted pre-operative risk reduction strategies are to be deployed effectively. Radiologically determined sarcopenia has been shown to predict outcomes across a range of intra-abdominal pathologies. Access to pre-operative cross-sectional imaging has resulted in a number of studies investigating the predictive value of radiologically assessed sarcopenia over recent years. This systematic review and meta-analysis aimed to determine whether radiologically determined sarcopenia predicts post-operative morbidity and mortality following abdominal surgery.
CENTRAL, EMBASE and MEDLINE databases were searched using terms to capture the concept of radiologically assessed sarcopenia used to predict post-operative complications in abdominal surgery. Outcomes included 30 day post-operative morbidity and mortality, 1-, 3- and 5-year overall and disease-free survival and length of stay. Data were extracted and meta-analysed using either random or fixed effects model (Revman 5.3).
A total of 24 studies involving 5267 patients were included in the review. The presence of sarcopenia was associated with a significant increase in major post-operative complications (RR 1.61 95% CI 1.24-4.15 p = <0.00001) and 30-day mortality (RR 2.06 95% CI 1.02-4.17 p = 0.04). In addition, sarcopenia predicted 1-, 3- and 5-year survival (RR 1.61 95% CI 1.36-1.91 p = <0.0001, RR 1.45 95% CI 1.33-1.58 p = <0.0001, RR 1.25 95% CI 1.11-1.42 p = 0.0003, respectively) and 1- and 3-year disease-free survival (RR 1.30 95% CI 1.12-1.52 p = 0.0008).
Peri-operative cross-sectional imaging may be utilised in order to predict those at risk of complications following abdominal surgery. These findings should be interpreted in the context of retrospectively collected data and no universal sarcopenic threshold. Targeted prehabilitation strategies aiming to reverse sarcopenia may benefit patients undergoing abdominal surgery.
如果要有效实施有针对性的术前风险降低策略，个体化风险预测至关重要。影像学确定的肌肉减少症已被证明可预测一系列腹腔内疾病的预后。近年来，由于能够获取术前横断面影像，已有多项研究探讨了影像学评估的肌肉减少症的预测价值。本系统评价和荟萃分析旨在确定影像学确定的肌肉减少症是否可预测腹部手术后的术后发病率和死亡率。
使用相关术语检索CENTRAL、EMBASE和MEDLINE数据库，以捕捉用于预测腹部手术术后并发症的影像学评估肌肉减少症的概念。结局指标包括术后30天的发病率和死亡率、1年、3年和5年的总生存率和无病生存率以及住院时间。使用随机或固定效应模型（Revman 5.3）提取数据并进行荟萃分析。
本评价共纳入24项研究，涉及5267例患者。肌肉减少症的存在与术后主要并发症（风险比1.61，95%置信区间1.24 - 4.15，p = <0.00001）和30天死亡率（风险比2.06，95%置信区间1.02 - 4.17，p = 0.04）的显著增加相关。此外，肌肉减少症可预测1年、3年和5年生存率（风险比分别为1.61，95%置信区间1.36 - 1.91，p = <0.0001；风险比1.45，95%置信区间1.33 - 1.58，p = <0.0001；风险比1.25，95%置信区间1.11 - 1.42，p = 0.0003）以及1年和3年无病生存率（风险比1.30，95%置信区间1.12 - 1.52，p = 0.0008）。
围手术期横断面影像可用于预测腹部手术后有并发症风险的患者。这些发现应结合回顾性收集的数据以及不存在通用的肌肉减少症阈值的情况来解读。旨在逆转肌肉减少症的有针对性的术前康复策略可能使接受腹部手术的患者受益。
