Namm Jukes P, Thakrar Kiran H, Wang Chi-Hsiung, Stocker Susan J, Sur Malini D, Berlin Jonathan, Dale William, Talamonti Mark S, Roggin Kevin K
Department of Surgery, Loma Linda University Health, Loma Linda, USA.
Department of Radiology, NorthShore University HealthSystem, Evanston, USA.
J Gastrointest Oncol. 2017 Dec;8(6):936-944. doi: 10.21037/jgo.2017.08.09.
Sarcopenia has been associated with increased adverse outcomes after major abdominal surgery. Sarcopenia defined as decreased muscle volume or increased fatty infiltration may be a proxy for frailty. In conjunction with other preoperative clinical risk factors, radiographic measures of sarcopenia using both muscle size and density may enhance prediction of outcomes after pancreaticoduodenectomy (PD) for malignancy.
Preoperative computed tomography (CT) scans of patients undergoing PD for malignancy were analyzed from a prospective pancreatic surgery database. Sarcopenia was assessed both manually and with a semi-automated technique by measuring the total psoas area index (TPAI) and average Hounsfield units (HU) at the L3 lumbar level to estimate psoas muscle volume and density, respectively. Adjusting for known pre-operative risk factors, preoperative sarcopenia measurements were analyzed relative to perioperative outcomes.
Sarcopenia assessments of 116 subjects demonstrated good correlation between the semi-automated and the manual techniques (P<0.0001). Lower TPAI (OR 0.34, P=0.009) and HU (OR 0.84, P=0.002) measurements were predictive of discharge to skilled nursing facility (SNF), but not major complications, length of stay, readmissions or recurrence on univariate analysis. Lower TPAI was protective against the risk of organ/space surgical site infection (SSI) including pancreatic fistula (OR 3.12, P=0.019). On multivariate analysis, the semi-automated measurements of TPAI and HU remained as independent predictors of organ/space SSI including pancreatic fistula (OR 4.23, P=0.014) and discharge to SNF (OR 0.79, P=0.019) respectively.
When combined with preoperative clinical assessments in patients with pancreatic malignancy, semi-automated sarcopenia metrics are a simple, reproducible method that may enhance prediction of outcomes after PD and help guide clinical management.
肌肉减少症与腹部大手术后不良结局的增加有关。肌肉减少症定义为肌肉量减少或脂肪浸润增加，可能是虚弱的一个指标。结合其他术前临床风险因素，使用肌肉大小和密度的肌肉减少症影像学测量方法可能会增强对恶性肿瘤胰十二指肠切除术（PD）后结局的预测。
从一个前瞻性胰腺手术数据库中分析接受恶性肿瘤PD患者的术前计算机断层扫描（CT）图像。通过测量L3腰椎水平的腰大肌总面积指数（TPAI）和平均亨氏单位（HU），分别手动和采用半自动技术评估肌肉减少症，以估计腰大肌的体积和密度。在调整已知的术前风险因素后，分析术前肌肉减少症测量值与围手术期结局的相关性。
对116名受试者的肌肉减少症评估表明，半自动技术与手动技术之间具有良好的相关性（P<0.0001）。较低的TPAI（比值比[OR]0.34，P=0.009）和HU（OR 0.84，P=0.002）测量值可预测患者出院后入住专业护理机构（SNF），但在单因素分析中对主要并发症、住院时间、再入院或复发无预测作用。较低的TPAI可降低包括胰瘘在内的器官/腔隙手术部位感染（SSI）风险（OR 3.12，P=0.019）。在多因素分析中，TPAI和HU的半自动测量值分别仍然是器官/腔隙SSI（包括胰瘘）（OR 4.23，P=0.014）和出院后入住SNF（OR 0.79，P=0.019）的独立预测因素。
在胰腺恶性肿瘤患者中，当与术前临床评估相结合时，半自动肌肉减少症指标是一种简单、可重复的方法，可能会增强对PD后结局预测并有助于指导临床管理。
