Matsui Ryota, Inaki Noriyuki, Tsuji Toshikatsu
Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Kanazawa Japan.
Department of Surgery Juntendo University Urayasu Hospital Urayasu Japan.
Ann Gastroenterol Surg. 2021 Mar 13;5(4):510-518. doi: 10.1002/ags3.12452. eCollection 2021 Jul.
Preoperative sarcopenia is an important risk factor for postoperative complications in patients with gastric cancer. However, the relationship between muscle quality and postoperative complications in patients with gastric cancer is inadequately studied. Therefore, we investigated the impact of preoperative muscle quality on severe postoperative complications after radical gastrectomy.
A total of 840 patients who underwent radical gastrectomy for p-stages I-III primary gastric cancer between April 2008 and June 2018 with preoperative computed tomography (CT) scans and body composition analysis were included. We measured intramuscular adipose tissue content (IMAC) as an indicator of muscle quality. A higher IMAC signified a poorer quality. All statistical analyses were performed with EZR, and a -value < 0.05 was considered statistically significant.
The low-IMAC and high-IMAC groups had 422 (50.2%) and 418 (49.8%) patients, respectively. The latter were older ( < 0.001), had higher body mass index (BMI) ( < 0.001), and higher rates of chronic kidney disease (CKD) ( = 0.002) and diabetes ( < 0.001). They had lower skeletal muscle indexes (SMI) ( = 0.011) and higher visceral fat areas (VFA) ( < 0.001). They also experienced more intraoperative blood loss ( < 0.001) and greater complications ( = 0.016). Multivariate analysis showed that high-IMAC was an independent risk factor for severe complications (odds ratio: 2.260, 95% confidence interval: 1.220-4.190, = 0.010).
Poor preoperative muscle quality is an independent risk factor for severe postoperative complications after radical gastrectomy in patients with gastric cancer.
术前肌肉减少症是胃癌患者术后并发症的重要危险因素。然而，胃癌患者肌肉质量与术后并发症之间的关系研究尚不充分。因此，我们研究了术前肌肉质量对根治性胃切除术后严重术后并发症的影响。
纳入2008年4月至2018年6月期间因I-III期原发性胃癌接受根治性胃切除术且术前行计算机断层扫描（CT）和身体成分分析的840例患者。我们测量肌内脂肪组织含量（IMAC）作为肌肉质量的指标。IMAC越高表明质量越差。所有统计分析均使用EZR进行，P值<0.05被认为具有统计学意义。
低IMAC组和高IMAC组分别有422例（50.2%）和418例（49.8%）患者。后者年龄更大（P<0.001），体重指数（BMI）更高（P<0.001），慢性肾脏病（CKD）发生率更高（P=0.002），糖尿病发生率更高（P<0.001）。他们的骨骼肌指数（SMI）更低（P=0.011），内脏脂肪面积（VFA）更高（P<0.001）。他们术中失血也更多（P<0.001），并发症更多（P=0.016）。多因素分析显示，高IMAC是严重并发症的独立危险因素（比值比：2.260，95%置信区间：1.220-4.190，P=0.010）。
术前肌肉质量差是胃癌患者根治性胃切除术后严重术后并发症的独立危险因素。
