Yu Dingye, Chen Weizhe, Zhang Fengmin, Huang Hongting, Yu Tianyu, Huang Guowei, Jiang Haojie, Dong Qiantong, Yu Zhen, Li Jiyu
Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.
Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
Eur J Surg Oncol. 2025 Jun 27;51(10):110299. doi: 10.1016/j.ejso.2025.110299.
Sarcopenia is common among individuals afflicted with gastric cancer (GC), and can culminate in unfavorable prognoses. Nevertheless, the efficacy of surgical interventions in GC patients with sarcopenia remains ambiguous. This study compared the prognostic value of laparoscopic and open radical gastrectomy in GC patients with sarcopenia.
GC patients with preoperative sarcopenia who underwent radical gastrectomy were enrolled in our study. The patients' outcomes were stratified based on the surgical approach. After correcting for bias in clinical characteristics using propensity score matching, the prognoses of two groups were compared, and independent risk factors for postoperative complications, overall survival (OS) and disease-free survival (DFS) were analyzed.
Our study included a total of 136 individuals after propensity score matching, with a postoperative complication rate of 39.0 %. Compared with patients who underwent open gastrectomy, those who opted for laparoscopic gastrectomy exhibited a lower incidence of surgical complications (13.2 % vs 35.3 %, P = 0.003) and better prognoses. By conducting a comprehensive analysis of statistical results, it had been determined that laparoscopic surgery was identified as an independent protective factor for surgical complications (OR = 0.244(0.098-0.607); P = 0.004), OS (HR = 0.522(0.0.297-0.919); P = 0.024), and DFS (HR = 0.459(0.234-0.902); P = 0.024).
Laparoscopic gastrectomy achieves a better long-term prognosis and significantly reduces the incidence of postoperative surgical complications for GC patients with sarcopenia.
肌肉减少症在胃癌（GC）患者中很常见，并可能导致不良预后。然而，手术干预对肌肉减少症GC患者的疗效仍不明确。本研究比较了腹腔镜根治性胃切除术和开放根治性胃切除术对肌肉减少症GC患者的预后价值。
本研究纳入了接受根治性胃切除术的术前肌肉减少症GC患者。根据手术方式对患者的结局进行分层。在使用倾向评分匹配校正临床特征的偏差后，比较两组的预后，并分析术后并发症、总生存期（OS）和无病生存期（DFS）的独立危险因素。
倾向评分匹配后，本研究共纳入136例患者，术后并发症发生率为39.0%。与接受开放胃切除术的患者相比，选择腹腔镜胃切除术的患者手术并发症发生率较低（13.2%对35.3%，P = 0.003），预后更好。通过对统计结果的综合分析，确定腹腔镜手术是手术并发症（OR = 0.244(0.098 - 0.607); P = 0.004）、OS（HR = 0.522(0.0.297 - 0.919); P = 0.024）和DFS（HR = 0.459(0.234 - 0.902); P = 0.024）的独立保护因素。
对于肌肉减少症GC患者，腹腔镜胃切除术可实现更好的长期预后，并显著降低术后手术并发症的发生率。
