Zhou Chong-Jun, Zhang Feng-Min, Zhang Fei-Yu, Yu Zhen, Chen Xiao-Lei, Shen Xian, Zhuang Cheng-Le, Chen Xiao-Xi
Department of Anorectal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; The First Clinical Medical Institute, Wenzhou Medical University, Wenzhou, China.
J Surg Res. 2017 May 1;211:137-146. doi: 10.1016/j.jss.2016.12.014. Epub 2016 Dec 22.
A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy.
We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia.
Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P < 0.001), compared with nonsarcopenic patients. The multivariate analysis demonstrated that sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P < 0.001) and the Charlson comorbidity index ≥2 (odds ratio: 3.357, 95% CI: 1.144-9.848, P = 0.027) were independent risk factors for postoperative complications.
Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer.
需要进行老年综合评估以识别老年胃癌高危患者。然而,目前的老年综合评估被认为要么耗时,要么主观。本研究旨在探讨肌肉减少症对接受根治性胃切除术的老年患者术后并发症的预测作用。
我们对2014年8月至2015年12月期间接受根治性胃切除术的患者进行了一项前瞻性研究。通过计算机断层扫描评估腰椎骨骼肌、握力和步速来定义肌肉减少症。
240例患者中有69例(28.8%)存在肌肉减少症,且与较低的体重指数、较低的血清白蛋白、较低的血红蛋白以及较高的2002年营养风险筛查评分相关。与非肌肉减少症患者相比,肌肉减少症患者的术后并发症显著增加(49.3%对24.6%,P<0.001)。多因素分析表明,肌肉减少症(比值比:2.959,95%可信区间:1.629 - 5.373,P<0.001)和Charlson合并症指数≥2(比值比:3.357,95%可信区间:1.144 - 9.848,P = 0.027)是术后并发症的独立危险因素。
肌肉减少症作为一种新的老年综合评估因素,是老年胃癌患者术后并发症的一个强有力的独立危险因素。