Centre of Inflammation and Metabolism/Centre for Physical Activity Research (CIM/CFAS), Rigshospitalet, Copenhagen, Denmark.
Department of Surgical Gastroenterology C, Rigshospitalet, Copenhagen, Denmark.
Ann Surg. 2018 Jul;268(1):58-69. doi: 10.1097/SLA.0000000000002679.
The aim of the study was to evaluate sarcopenia as a predictor of postoperative risk of major and total complications after surgery for gastrointestinal cancer.
Sarcopenia is associated with poor survival in gastrointestinal cancer patients, but the role of sarcopenia as prognostic tool in surgical oncology has not been established, and no consensus exists regarding assessment and management of sarcopenic patients.
We performed a systematic search for citations in EMBASE, Web of Science, and PubMed from 2004 to January 31, 2017. Random effects meta-analyses were used to estimate the pooled risk ratio for postoperative complications by Clavien-Dindo grade (total complications: grade ≥2; major complications: grade ≥3) in patients with sarcopenia versus patients without sarcopenia. Stratified analyses were performed by sarcopenia criteria, cutoff level, assessment methods, study quality, cancer diagnosis, and "Enhanced Recovery After Surgery" care.
Twenty-nine studies (n = 7176) were included with sarcopenia prevalence ranging between 12% and 78%. Preoperative incidence of sarcopenia was associated with increased risk of major complications (risk ratio 1.40; 95% confidence interval, 1.20-1.64; P < 0.001; I = 52%) and total complications (risk ratio 1.35; 95% confidence interval, 1.12-1.61; P = 0.001; I = 60%). Moderate heterogeneity was found for both meta-analyses. Subgroup analyses showed that sarcopenia remained a consistent risk factor across stratification by sarcopenia criteria, assessment methods, study quality, and diagnoses.
Sarcopenia was associated with an increased risk of complications after gastrointestinal tumor resection, but lack of methodological consensus hampers the interpretation and clinical utilization of these findings. Combining assessment of muscle mass with measures of physical function may increase the prognostic value and accuracy in preoperative risk stratification.
本研究旨在评估肌肉减少症作为胃肠道癌症手术后发生重大和总体并发症风险的预测因子。
肌肉减少症与胃肠道癌症患者的不良生存相关，但肌肉减少症作为外科肿瘤学中的预后工具的作用尚未确定，且对于肌肉减少症患者的评估和管理尚无共识。
我们对 2004 年 1 月 31 日至 2017 年 1 月 31 日期间 EMBASE、Web of Science 和 PubMed 中的引文进行了系统检索。采用随机效应荟萃分析，估计有和无肌肉减少症患者的术后并发症 Clavien-Dindo 分级（总并发症：分级≥2；重大并发症：分级≥3）的汇总风险比。采用肌肉减少症标准、截断值、评估方法、研究质量、癌症诊断和“加速康复外科”护理进行分层分析。
共纳入 29 项研究（n=7176），肌肉减少症的患病率在 12%至 78%之间。术前肌肉减少症的发生率与重大并发症（风险比 1.40；95%置信区间，1.20-1.64；P<0.001；I=52%）和总并发症（风险比 1.35；95%置信区间，1.12-1.61；P=0.001；I=60%）风险增加相关。这两项荟萃分析均存在中度异质性。亚组分析显示，肌肉减少症仍然是肌肉减少症标准、评估方法、研究质量和诊断分层的一致危险因素。
肌肉减少症与胃肠道肿瘤切除术后并发症风险增加相关，但方法学共识的缺乏妨碍了对这些发现的解释和临床应用。将肌肉量评估与身体功能测量相结合，可能会提高术前风险分层的预后价值和准确性。
