Abstract
Introduction: Upper gastrointestinal (UGI) surgery is by definition high risk and frequently performed in malnourished patients with a significant incidence of sarcopenia (age-associated loss of skeletal muscle mass and function). Nutritional support is an integral component of enhanced recovery protocols (ERP) to mitigate post-operative risk, and the aim of this study was to investigate the prognostic significance of sarcopenia as defined by CT density of muscle mass in UGI cancer. Methods: One hundred and seven consecutive patients undergoing surgery for UGI cancer [median age 66 yr, 79 m, 55 esophageal (46 ACA, 9 SCC), 52 gastric cancer] were studied prospectively. The axial CT slice at the upper border of the fourth lumbar vertebra was identified and a region of interest was drawn around each psoas muscle. The mean psoas muscle CT density (PMD) was calculated within the region in Hounsfield units (HU) by the Agfa PACS system, and the greater of the two density measurements was used for analysis. The primary outcome measure was survival. Results: Median PMD was 49.25 (range -5.55 to 73.73) HU. Nineteen patients (17.8%) had low PMD ( 40 HU 70.4%, p<0.001). On multivariate analysis only rTNM stage was independently associated with survival (HR 2.157, 95% CI 1.450-3.209, p<0.001). Conclusion: CT defined psoas muscle density (PMD) and by implication sarcopenia, is an important and new prognostic indicator in UGI cancer. Patients identified as such should enter targeted strategic ERP protocols.
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