Plastic & Reconstructive Surgeons, Renton, Washington.
Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Surg Oncol. 2020 Dec;122(7):1490-1497. doi: 10.1002/jso.26171. Epub 2020 Aug 14.
Sarcopenia is an objective measure of patient frailty and is a predictor of adverse surgical outcomes. We hypothesized that sarcopenia is associated with increased surgical site occurrence (SSO) and hernia occurrences in patients undergoing oncologic abdominal wall reconstruction.
Consecutive patients who underwent abdominal wall reconstruction (AWR) for an abdominal wall ablative defect at a single center from 2005 to 2015 were evaluated. The total psoas index (TPI) was used to define sarcopenia. The primary endpoint of the study was hernia occurrence; (SSO) was a secondary outcome measure.
Eighty-six patients met the inclusion criteria. Multivariate analysis demonstrated that sarcopenia increased the risk of hernia more than threefold, trending toward significance (OR = 3.3; 95% CI: 0.69-15.4; P = .13). Multivariate logistic regression demonstrated that preoperative radiotherapy (OR = 4.8, 95% CI: 1.4-16; P = .01) and obesity (OR = 4.9, 95% CI: 1.5-16.3; P =.009) were independent predictors of developing an SSO.
Sarcopenia, as defined by TPI, is correlated with hernia occurrence, but not SSO. These findings emphasize the importance of preoperative fitness and nutritional optimization and provide useful information for preoperative counseling and risk stratification.
肌少症是患者虚弱的客观指标，是不良手术结局的预测因素。我们假设肌少症与接受肿瘤腹壁重建的患者手术部位发生（SSO）和疝发生增加有关。
对 2005 年至 2015 年在单一中心接受腹壁切除缺陷腹壁重建（AWR）的连续患者进行评估。总腰大肌指数（TPI）用于定义肌少症。该研究的主要终点是疝发生；（SSO）是次要结局测量指标。
86 名患者符合纳入标准。多变量分析表明，肌少症使疝的风险增加了三倍以上，有显著趋势（OR=3.3；95%CI：0.69-15.4；P=.13）。多变量逻辑回归表明，术前放疗（OR=4.8，95%CI：1.4-16；P=.01）和肥胖（OR=4.9，95%CI：1.5-16.3；P=.009）是发生 SSO 的独立预测因素。
TPI 定义的肌少症与疝发生相关，但与 SSO 无关。这些发现强调了术前健康和营养优化的重要性，并为术前咨询和风险分层提供了有用信息。
