Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark.
Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Clin Nutr ESPEN. 2024 Dec;64:263-273. doi: 10.1016/j.clnesp.2024.10.003. Epub 2024 Oct 11.
The association between sarcopenia and postoperative complications has been widely reported in patients with cancer. Yet, the lack of standardized population-specific diagnostic cut-off points and assessments of muscle strength is hampering prospective clinical utilization. Therefore, we aimed to examine the impact of sarcopenia, defined by both regional and international cut-off points, along with various methods of measuring skeletal muscle and muscle strength, on the risk of postoperative complications following pancreatic resection.
The present prospective observational study enrolled patients scheduled for pancreatic resection. Body composition was assessed by DXA and CT prior to surgery. We applied the algorithm and cut-off points suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) as well as cut-off points from a Danish normative reference population to classify patients as sarcopenic. Physical performance was assessed by usual gait speed while muscle strength was assessed by handgrip strength, leg extensor power, and 30-s sit-to-stand. Postoperative complications within 30 days following surgery were classified according to the Clavien-Dindo classification and the American College of Surgeons National Surgical Quality Improvement Program. Complications graded ≥3 according to Clavien-Dindo were considered major complications.
A total of 134 patients with a mean age of 67 years (SD: 9) were enrolled of whom most underwent pancreaticoduodenectomy (64 %). Using international cut-off points, eight patients (7 %) were classified as sarcopenic using CT scans and sarcopenia was associated with an increased risk of major postoperative complications (RR 2.14 [1.33-3.43]). Using DXA, four patients (3 %) were classified as sarcopenic, all of whom experienced a major complication. With regional cut-off points, 16 patients (13 %) were classified as sarcopenic using CT scans, but sarcopenia was not associated with major complications (RR 1.39 [0.80-2.42]). Nine patients (7 %) were classified as sarcopenic using DXA, but sarcopenia was not associated with major complications (RR 1.15 [0.54-2.48]). Across the different muscle strength assessment methods, handgrip strength consistently demonstrated a stronger association with postoperative complications.
Sarcopenia defined according to the EWGSOP criteria and with international cut-off points is associated with an increased risk of postoperative complications following pancreatic resection. Using regionally based cut-off points, the prevalence of sarcopenia is higher, but it does not confer a higher postoperative complication risk. The use of different muscle strength assessment methods results in vastly different estimates of prevalence of low strength and associations with postoperative outcomes.
在癌症患者中，肌肉减少症与术后并发症之间的关联已被广泛报道。然而，缺乏标准化的人群特异性诊断截断值和肌肉力量评估方法，阻碍了其在临床中的前瞻性应用。因此，我们旨在研究通过区域和国际截断值定义的肌肉减少症，以及各种测量骨骼肌和肌肉力量的方法，对胰腺切除术后术后并发症风险的影响。
本前瞻性观察研究纳入了计划接受胰腺切除术的患者。在术前通过 DXA 和 CT 评估身体成分。我们应用欧洲老年人肌肉减少症工作组（EWGSOP）提出的算法和截断值以及丹麦参考人群的截断值来对患者进行肌肉减少症分类。通过惯用步速评估身体活动能力，通过握力、腿部伸肌力量和 30 秒坐立试验评估肌肉力量。术后 30 天内根据 Clavien-Dindo 分类和美国外科医师学会国家手术质量改进计划对并发症进行分类。根据 Clavien-Dindo 分级≥3 的并发症被认为是主要并发症。
共纳入 134 名平均年龄为 67 岁（SD：9）的患者，其中大多数接受胰十二指肠切除术（64%）。使用国际截断值，8 名患者（7%）通过 CT 扫描被诊断为肌肉减少症，肌肉减少症与术后主要并发症的风险增加相关（RR 2.14[1.33-3.43]）。使用 DXA，4 名患者（3%）被诊断为肌肉减少症，均发生主要并发症。使用区域截断值，16 名患者（13%）通过 CT 扫描被诊断为肌肉减少症，但肌肉减少症与主要并发症无关（RR 1.39[0.80-2.42]）。9 名患者（7%）通过 DXA 被诊断为肌肉减少症，但肌肉减少症与主要并发症无关（RR 1.15[0.54-2.48]）。在不同的肌肉力量评估方法中，握力与术后并发症的相关性始终更强。
根据 EWGSOP 标准和国际截断值定义的肌肉减少症与胰腺切除术后并发症风险增加相关。使用基于区域的截断值，肌肉减少症的患病率较高，但不会增加术后并发症风险。使用不同的肌肉力量评估方法会导致对低强度的估计和对术后结果的关联存在很大差异。
