Kim Hae Young, Chang Won, Lee Sungsoo, Cho Jungheum, Kang So Hyun, Lee Yoon Jin, Kim Young Hoon
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Commun Med (Lond). 2025 Jun 13;5(1):231. doi: 10.1038/s43856-025-00931-6.
Patients who undergo gastrectomy may experience changes in their body composition, which may in turn affect survival. However, whether endoscopic resection differs from gastrectomy in its effect on body composition remains unclear.
This retrospective study included 2267 patients who received either gastrectomy or endoscopic resection for intramucosal gastric cancer. Transverse images at the L3 vertebra level of the patient's staging and follow-up CTs were segmented for the measurement of fat and skeletal muscle areas. In 1134 patients who were propensity score-matched, as well as in all 2267 patients, gastrectomy vs. endoscopic resection was compared in terms of the percentage change in skeletal muscle, visceral fat, subcutaneous fat, and the proportion of newly developed sarcopenia.
Changes in skeletal muscle, visceral fat, and subcutaneous fat are all greater following gastrectomy (p value < 0.001 for all). The change in skeletal muscle is -2.9 % (-3.4%, 2.3%) and 0.3% (-0.2%, 0.8%) following gastrectomy and endoscopic resection, respectively. The change in visceral fat is -50.2 % (-54.1%, -46.3%) and 8.6% (1.7%, 15.6%), respectively. The change in subcutaneous fat is -26.5% (-30.4%, -22.5%) and 3.9% (-0.3%, 8.0%), respectively. The proportion of newly developed sarcopenia is also higher following gastrectomy (1.9% vs. 3.4%), although the difference was not significant. The results are also consistently observed for all patients, regardless of propensity score-matching.
Change in body composition is greater after gastrectomy than after endoscopic resection. Such knowledge may contribute to refining the criteria for treatment selection between gastrectomy and endoscopic resection in patients with intra-mucosal gastric cancer.
接受胃切除术的患者可能会经历身体成分的变化，这反过来可能会影响生存。然而，内镜切除术对身体成分的影响是否与胃切除术不同仍不清楚。
这项回顾性研究纳入了2267例因黏膜内胃癌接受胃切除术或内镜切除术的患者。对患者分期和随访CT的L3椎体水平的横向图像进行分割，以测量脂肪和骨骼肌面积。在1134例倾向评分匹配的患者以及所有2267例患者中，比较了胃切除术与内镜切除术在骨骼肌、内脏脂肪、皮下脂肪百分比变化以及新发生肌肉减少症比例方面的差异。
胃切除术后骨骼肌、内脏脂肪和皮下脂肪的变化均更大（所有p值均<0.001）。胃切除术后骨骼肌的变化分别为-2.9%（-3.4%，-2.3%），内镜切除术后为0.3%（-0.2%，0.8%）。内脏脂肪的变化分别为-50.2%（-54.1%，-46.3%）和8.6%（1.7%，15.6%）。皮下脂肪的变化分别为-26.5%（-30.4%，-22.5%）和3.9%（-0.3%，8.0%）。胃切除术后新发生肌肉减少症的比例也更高（1.9%对3.4%），尽管差异不显著。无论倾向评分匹配如何，所有患者均一致观察到该结果。
胃切除术后身体成分的变化比内镜切除术后更大。这些知识可能有助于完善黏膜内胃癌患者胃切除术和内镜切除术之间治疗选择的标准。
