术前肌肉减少症对胃癌患者术后并发症的不良影响。
Adverse Effects of Preoperative Sarcopenia on Postoperative Complications of Patients With Gastric Cancer.
作者信息
Tamura Tatsuro, Sakurai Katsunobu, Nambara Mikio, Miki Yuichiro, Toyokawa Takahiro, Kubo Naoshi, Tanaka Hiroaki, Muguruma Kazuya, Yashiro Masakazu, Ohira Masaichi
机构信息
Department of Gastroenterological Surgery, Osaka City University, Graduate School of Medicine, Osaka, Japan
Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan.
出版信息
Anticancer Res. 2019 Feb;39(2):987-992. doi: 10.21873/anticanres.13203.
BACKGROUND
Sarcopenia is known to have an important influence on postoperative complications in several diseases, and on the prognosis of patients with cancer. However, whether sarcopenia is associated with complications and prognosis after gastrectomy in patients with gastric cancer remains controversial. This study evaluated the impact of the preoperative muscle mass on postoperative complications of gastric cancer surgery.
MATERIALS AND METHODS
The muscle mass of 153 patients who underwent gastrectomy for gastric cancer from January 2014 to August 2016 was assessed before surgery by a multifrequency bioelectrical impedance analysis (In Body 3.0; Biospace, Tokyo, Japan) and was expressed as the muscle mass index (MMI). Sarcopenia was defined as an MMI value of one standard deviation or more below the gender-specific mean MMI. Complications of Clavien-Dindo grade 2 or more were defined as significant postoperative complications. The impact of preoperative sarcopenia on postoperative infectious complications was analyzed by univariate and multivariate analyses.
RESULTS
A total of 153 patients were analyzed, sarcopenia was present in 24 out of 153 patients (15.7%). Thirty (19.6%) patients developed postoperative complications, 20 (13.1%) of which were infectious complications. Sarcopenia was significantly associated with age, body mass index, serum albumin, pulmonary disease in comorbidities, operative time, surgical approach, and postoperative complications. The univariate analyses revealed that male sex, sarcopenia, total gastrectomy, laparotomy, and intraoperative blood loss were associated with postoperative infectious complications. In the multivariate analyses, sarcopenia and intraoperative blood loss ≥400 ml were independently associated with postoperative infectious complications.
CONCLUSION
Preoperative sarcopenia was found to be an independent risk factor for postoperative infectious complications in gastric cancer patients.
背景
已知肌肉减少症对多种疾病的术后并发症以及癌症患者的预后有重要影响。然而，肌肉减少症是否与胃癌患者胃切除术后的并发症及预后相关仍存在争议。本研究评估了术前肌肉量对胃癌手术术后并发症的影响。
材料与方法
对2014年1月至2016年8月期间接受胃癌胃切除术的153例患者，术前采用多频生物电阻抗分析（In Body 3.0；日本东京百利达公司）评估其肌肉量，并表示为肌肉量指数（MMI）。肌肉减少症定义为MMI值低于特定性别的平均MMI一个标准差或更多。将Clavien-Dindo 2级或更高等级的并发症定义为严重术后并发症。通过单因素和多因素分析评估术前肌肉减少症对术后感染性并发症的影响。
结果
共分析了153例患者，其中153例患者中有24例（15.7%）存在肌肉减少症。30例（19.6%）患者发生术后并发症，其中20例（13.1%）为感染性并发症。肌肉减少症与年龄、体重指数、血清白蛋白、合并症中的肺部疾病、手术时间、手术方式及术后并发症显著相关。单因素分析显示，男性、肌肉减少症、全胃切除术、开腹手术及术中失血与术后感染性并发症相关。多因素分析中，肌肉减少症及术中失血≥400 ml与术后感染性并发症独立相关。
结论
术前肌肉减少症是胃癌患者术后感染性并发症的独立危险因素。
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