The Analysis of Surgical Outcomes in Operable Gastric Cancer Patients Presenting With or Without Sarcopenia.

Abstract

We aimed to identify the patients with increased risk of post-operative complications using pre-operative sarcopenia as an indicator of adverse outcome in gastric cancer patients undergoing resection. This study was a prospective observational cohort study including patients with adenocarcinoma of stomach, undergoing gastric resection with curative intent. All the patient underwent pre-operative evaluation of sarcopenia including skeletal muscle index (SMI) measurements and hand grip strength (HGS) analysis. The post-operative parameters assessed were the time to initiate enteral feeding, the time to pass first flatus, post-operative complications, post-operative hospital stay, and histopathological staging of the resected specimen. All these parameters were compared between the sarcopenia and non-sarcopenia arms to obtain the final results. The total number of patients enrolled was 72 (46 male, 26 female). The mean SMI of the study cohort was 47.1 cm2/m2 and the mean HGS was 29.35kg. Thirty-six patients (24 male, 12 female) were sarcopenic pre-operatively. Sixty-two patients underwent subtotal gastrectomy with D2 lymphadenectomy, and 10 patients underwent total gastrectomy with D2 lymphadenectomy. The median time to pass flatus was 4days, the median time to initiation of enteral feeding was 4days, and the median post-operative hospital stay was 12days. Majority of the study patients had a pT3N1-2 disease. Sarcopenia was significantly associated with worsening ECOG performance status (p = 0.001), delay in passage of first flatus post-operatively (p = 0.017), higher post-operative complications (p = 0.012), higher T stage (p = 0.040), and higher N stage (p = 0.001). But there was no significant association between sarcopenia and time to initiation of enteral feeding and post-operative hospital stay. Sarcopenia is an independent prognostic factor for adverse short-term post-operative outcomes in patients undergoing curative intent resection of gastric cancer.