Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
Anticancer Res. 2023 Sep;43(9):4207-4212. doi: 10.21873/anticanres.16612.
BACKGROUND/AIM: Sarcopenia is a progressive and generalized muscle disorder correlated with an increased risk of adverse outcomes, including falls, fractures, physical disability and mortality. Moreover, sarcopenia is associated with short- and long-term outcomes after surgery in patients with gastrointestinal malignancies. Additionally, severe skeletal muscle loss after surgery reduces quality of life. In this study, we analyzed the perioperative risk factors for skeletal muscle loss after gastrectomy in elderly patients undergoing radical gastrectomy for gastric cancer.
In this case-control study, we enrolled patients aged ≥75 years who underwent radical gastrectomy for gastric cancer between January 2014 and December 2020 at our Institution. The psoas muscle index was used to assess skeletal muscle mass. They were divided into two groups-muscle depletion (D group) and no depletion (ND group)-depending on the ratio of skeletal muscle loss before and after gastrectomy.
The D and ND groups comprised 34 and 41 patients, respectively. Univariate analysis showed that open gastrectomy was a potential risk factor for postoperative skeletal muscle loss in elderly gastric cancer patients (p=0.017). In multiple logistic regression analysis using the following variables: sex, operation and approach, the D group had a significantly higher proportion of patients who underwent open surgery than the ND group (p=0.032).
Open gastrectomy is an independent risk factor for the progression of sarcopenia after gastrectomy in elderly patients with gastric cancer. Laparoscopic surgery is an eligible method for preserving skeletal muscle mass in elderly patients with gastric cancer.
背景/目的：肌肉减少症是一种进行性和全身性的肌肉疾病，与不良结局风险增加相关，包括跌倒、骨折、身体残疾和死亡。此外，肌肉减少症与胃肠道恶性肿瘤患者手术后的短期和长期结局相关。此外，手术后严重的骨骼肌丢失会降低生活质量。在这项研究中，我们分析了老年胃癌患者接受根治性胃切除术后骨骼肌丢失的围手术期危险因素。
在这项病例对照研究中，我们纳入了 2014 年 1 月至 2020 年 12 月期间在我院接受根治性胃切除术治疗胃癌的年龄≥75 岁的患者。使用腰大肌指数评估骨骼肌量。根据胃切除术前、后骨骼肌丢失的比例，将他们分为两组-肌肉消耗组（D 组）和无肌肉消耗组（ND 组）。
D 组和 ND 组分别包括 34 例和 41 例患者。单因素分析显示，开放性胃切除术是老年胃癌患者术后骨骼肌丢失的潜在危险因素（p=0.017）。在使用以下变量的多因素逻辑回归分析中：性别、手术方式和入路，D 组中接受开放性手术的患者比例明显高于 ND 组（p=0.032）。
开放性胃切除术是老年胃癌患者胃切除术后肌肉减少症进展的独立危险因素。腹腔镜手术是保留老年胃癌患者骨骼肌量的一种合适方法。
