Department of Gastrointestinal Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, 430000, China.
World J Surg Oncol. 2023 Feb 22;21(1):57. doi: 10.1186/s12957-023-02950-w.
With better patient selection and the increasing experience in patients undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) combined surgery, the rate of severe postoperative complications and mortality decreased significantly. However, leukopenia and neutropenia were still a particular concern, and their relation to sarcopenia was not clarified.
Data of consecutive patients who underwent HIPEC for gastrointestinal cancer were collected and analyzed retrospectively between September 2020 and August 2022. Sarcopenia was assessed using psoas muscle index (PMI) at the L3 level on preoperative computed tomography (CT).
Among 103 patients enrolled, 37 (35.9%) were classified as sarcopenic. Most leukopenia and neutropenia occurred during the hospital leaving period after HIPEC and surgery. Before the first time of postoperative chemotherapy, the blood tests revealed 11 (29.73%) and 6 (9.09%) patients were diagnosed with neutropenia in sarcopenia and no sarcopenia groups, respectively. Logistic regression analysis revealed sarcopenia was independently associated with the increased risk of neutropenia (OR 5.58, 95% CI 1.70-18.29, p = 0.005). An incremental albumin level was protective against the occurrence of leukopenia and neutropenia.
Sarcopenia and low albumin level were significantly associated with an increased rate of delayed neutropenia after HIPEC in that disease setting and could be the preoperative risk predictors.
随着对接受腹腔内热灌注化疗（HIPEC）联合手术的患者更好的选择和经验的增加，严重术后并发症和死亡率显著下降。然而，白细胞减少和中性粒细胞减少仍然是一个特别关注的问题，它们与肌肉减少症的关系尚未阐明。
回顾性收集了 2020 年 9 月至 2022 年 8 月期间连续接受 HIPEC 治疗胃肠道癌症的患者数据，并进行了分析。使用术前 CT 检查 L3 水平的竖脊肌指数（PMI）评估肌肉减少症。
在纳入的 103 例患者中，37 例（35.9%）被归类为肌肉减少症。大多数白细胞减少和中性粒细胞减少发生在 HIPEC 和手术后的住院期间。在第一次术后化疗前，血液检查显示在肌肉减少症和非肌肉减少症组中，分别有 11 例（29.73%）和 6 例（9.09%）患者被诊断为中性粒细胞减少症。逻辑回归分析显示，肌肉减少症与中性粒细胞减少症的风险增加独立相关（OR 5.58，95%CI 1.70-18.29，p=0.005）。白蛋白水平升高可预防白细胞减少和中性粒细胞减少的发生。
在这种疾病情况下，肌肉减少症和低白蛋白水平与 HIPEC 后迟发性中性粒细胞减少的发生率增加显著相关，可能是术前的风险预测因素。
