Abstract
Abstract Low muscle mass is associated with postoperative complications after oesophago-gastric (OG) cancer surgery, but data demonstrating a negative impact on long-term survival is limited. Clinical tools to accurately stratify risk based on nutritional status would be of considerable value. The Global Leadership Initiative on Malnutrition (GLIM) is a consensus framework for diagnosing malnutrition. We aimed to assess the prevalence of malnutrition defined by GLIM and the impact on postoperative outcomes after OG cancer surgery. Patients who underwent radical OG cancer surgery with preoperative abdominal computed tomography (CT) imaging were included. Retrospective collection of preoperative data identified malnutrition using the GLIM definition. The phenotypic criterion includes body mass index (BMI), unintentional weight loss, and muscle mass. All patients had a malignant disease and met the aetiologic criterion of an inflammatory condition. Nutrition status was categorised as no malnutrition, mild–moderate, and severe. Malnutrition diagnosis was assessed against oncological, surgical, and survival data. Low skeletal muscle index (cm2/m2) measured by CT was determined using predefined cut-points.1 Cox regression analysis determined predictors of overall survival. One-hundred and eight patients were included. Malnutrition using GLIM criteria was present in 72% of patients (n = 78), including mild–moderate (n = 45) and severe malnutrition (n = 33). The predominant phenotypic criterion for GLIM malnutrition was low muscle mass (n = 66, 61%), followed by preoperative weight loss (n = 46, 43%) and low BMI (n = 11, 10%). Malnutrition was associated with postoperative pneumonia (26.9% vs 6.7% well-nourished, p = 0.010). Severe malnutrition was associated with poorer 5-year overall survival (p = 0.022) (Figure 1) and, along with stage 4 disease, higher age, and severe postoperative complications, remained an independent predictor of survival after multivariate analysis (OR 2.51, 95% CI 1.20–5.24, p = 0.014). Malnutrition defined by GLIM is highly prevalent and is associated with postoperative pneumonia. Severe malnutrition is an independent predictor of poorer overall survival. Muscle mass is a key phenotypic GLIM criterion, and the GLIM diagnostic framework is potentially a practical and valuable component of preoperative risk stratification in OG cancer surgery.
Published Version
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