Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Ann Nutr Metab. 2019;75(4):213-222. doi: 10.1159/000504283. Epub 2019 Dec 17.
Sarcopenia is a syndrome in which skeletal muscle reduction is the main manifestation of age-related and/or disease-related malnutrition associated with postoperative complications and mortality.
The aim of the current study was to investigate the association between sarcopenia and postoperative complications as well as the nutrition risk of patients with gastric cancer (GC) who received gastrectomy. In addition, a comparative analysis was performed to evaluate the diagnostic accuracy of total psoas muscle area (TPA) and skeletal muscle area (SMA) in sarcopenia.
Preoperative computed tomography scans were obtained from 279 GC patients who received a gastrectomy from June 2011 to May 2016. TPA and SMA at the level of the third lumbar vertebra (L3) were used as the sarcopenia diagnostic index. Patients were diagnosed with sarcopenia via the total psoas muscle index (TPI) and skeletal muscle index (SMI) methods. TPI and SMI were normalized with the square of the patient's height (m2) by TPA and SMA. The Clavien-Dindo complications score system was used to classify the complication extent after gastrectomy. Univariate and multivariate logistic regression analyses were carried out to evaluate the risk factors for postoperative complications.
A total of 68 and 125 patients were diagnosed with sarcopenia by TPI and SMI, respectively. Eighty-eight (31.5%) patients experienced postoperative complications. Patients with sarcopenia also had a significantly extended postoperative stay (TPI-sarcopenia, 15.0 days vs. non-sarcopenia, 11.0 days, p < 0.001; and SMI-sarcopenia, 14.0 days vs. non-sarcopenia, 11.0 days, p < 0.001) and hospital stay (TPI-sarcopenia, 22.5 days vs. non-sarcopenia, 17.0 days, p < 0.001; and SMI-sarcopenia, 21.0 days vs. non-sarcopenia, 16.5 days, p < 0.001). Multivariate logistic analysis showed that both TPI-sarcopenia (OR 7.561, p < 0.001) and SMI-sarcopenia (OR 10.085, p < 0.001) were associated with the risk of postoperative complications. Furthermore, univariate analysis showed a high correlation between nutrition risk screening 2002 (NRS2002) and sarcopenia (p < 0.001). A total of 54 (79.4%) of the 68 patients who were classified as having sarcopenia by TPI and 94 (75.3%) of the 125 patients who were classified as having sarcopenia by SMI were diagnosed with nutritional risk.
Sarcopenia is associated with the total length of hospital stay, postoperative hospital stay, and severe complications in GC patients undergoing gastrectomy. Moreover, SMI may be a more meaningful index than TPI in reducing the rate of misdiagnosis and in predicting adverse perioperative risk. In addition, sarcopenia may cause severe malnutrition and increases perioperative adverse risk. Thus, both sarcopenia and the NRS2002 nutritional score should be assessed during preoperative nutritional screening and evaluation for GC patients.
肌少症是一种以骨骼肌减少为主要表现的综合征，与年龄相关和/或疾病相关的营养不良有关，与术后并发症和死亡率有关。
本研究旨在探讨胃癌（GC）患者接受胃切除术后肌少症与术后并发症的关系，以及患者的营养风险。此外，还进行了对比分析，以评估总腰大肌面积（TPA）和骨骼肌面积（SMA）在肌少症诊断中的准确性。
从 2011 年 6 月至 2016 年 5 月接受胃切除术的 279 例 GC 患者中获取术前计算机断层扫描（CT）。TPA 和第三腰椎（L3）水平的 SMA 被用作肌少症诊断指标。通过总腰大肌指数（TPI）和骨骼肌指数（SMI）方法对患者进行肌少症诊断。通过 TPA 和 SMA 将 TPI 和 SMI 标准化为患者身高的平方（m2）。使用 Clavien-Dindo 并发症评分系统对胃切除术后的并发症程度进行分类。采用单因素和多因素 logistic 回归分析评估术后并发症的危险因素。
共有 68 例和 125 例患者分别通过 TPI 和 SMI 诊断为肌少症。88 例（31.5%）患者发生术后并发症。肌少症患者的术后住院时间（TPI-肌少症，15.0 天 vs. 非肌少症，11.0 天，p < 0.001；和 SMI-肌少症，14.0 天 vs. 非肌少症，11.0 天，p < 0.001）和总住院时间（TPI-肌少症，22.5 天 vs. 非肌少症，17.0 天，p < 0.001；和 SMI-肌少症，21.0 天 vs. 非肌少症，16.5 天，p < 0.001）均显著延长。多因素 logistic 分析显示，TPI-肌少症（OR 7.561，p < 0.001）和 SMI-肌少症（OR 10.085，p < 0.001）均与术后并发症的风险相关。此外，单因素分析显示，营养风险筛查 2002（NRS2002）与肌少症高度相关（p < 0.001）。通过 TPI 诊断为肌少症的 68 例患者中，有 54 例（79.4%）和通过 SMI 诊断为肌少症的 125 例患者中，有 94 例（75.3%）被诊断为营养风险。
肌少症与 GC 患者胃切除术后的总住院时间、术后住院时间和严重并发症有关。此外，SMI 可能比 TPI 更有意义，可降低误诊率，并预测围手术期不良风险。此外，肌少症可能导致严重的营养不良，增加围手术期不良风险。因此，在术前营养筛查和评估 GC 患者时，应同时评估肌少症和 NRS2002 营养评分。
