Preoperative Sarcopenia Research Articles

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta-analysis.

BackgroundSarcopenia might function as an indicator for frailty, and as such as a risk factor for the development of postoperative complications. The aim of this study was to meta‐analyse the relation between preoperative sarcopenia and the development of severe postoperative complications in patients undergoing oncological surgery.MethodsPubMed and Embase databases were systematically searched from inception until May 2018. Included were studies reporting on the incidence of severe postoperative complications and radiologically determined preoperative sarcopenia. Studies reporting the skeletal muscle as a continuous variable only were excluded. Data were extracted independently by two reviewers. Random effect meta‐analyses were applied to estimate the pooled odds ratio (OR) with 95% confidence intervals (95% CI) for severe postoperative complications, defined as Clavien‐Dindo grade ≥3, including 30‐day mortality. Heterogeneity was evaluated with I 2 testing. Analyses were performed overall and stratified by measurement method, tumour location and publication date.ResultsA total of 1924 citations were identified, and 53 studies (14 295 patients) were included in the meta‐analysis. When measuring the total skeletal muscle area, 43% of the patients were sarcopenic, versus 33% when measuring the psoas area. Severe postoperative complications were present in 20%, and 30‐day mortality was 3%. Preoperative sarcopenia was associated with an increased risk of severe postoperative complications (ORpooled: 1.44, 95% CI: 1.24–16.8, P<0.001, I 2=55%) and 30‐day mortality (ORpooled: 2.15, 95% CI: 1.46–3.17, P<0.001, I 2=14%). A low psoas mass was a stronger predictor for severe postoperative complications compared with a low total skeletal muscle mass (ORpooled: 2.06, 95% CI: 1.37–3.09, ORpooled: 1.32, 95% CI: 1.14–1.53, respectively) and 30‐day mortality [ORpooled: 6.17 (95% CI: 2.71–14.08, ORpooled: 1.80 (95% CI: 1.24–2.62), respectively]. The effect was independent of tumour location and publication date.ConclusionsThe presence of low psoas mass prior to surgery, as an indicator for sarcopenia, is a common phenomenon and is a strong predictor for the development of postoperative complications. The presence of low total skeletal muscle mass, which is even more frequent, is a less informative predictor for postoperative complications and 30‐day mortality. The low heterogeneity indicates that the finding is consistent over studies. Nevertheless, the value of sarcopenia relative to other assessments such as frailty screening is not clear. Research is needed in order to determine the place of sarcopenia in future preoperative risk stratification.

Impact of Sarcopenia on Outcomes of Autologous Head and Neck Free Tissue Reconstruction

Sarcopenia has been implicated as a positive predictor of postsurgical complications. Its role in head and neck (H&N) free flap reconstruction has yet to be examined. Our study aimed to determine the clinical impact of sarcopenia on postoperative outcomes in patients receiving autologous free tissue reconstruction for H&N cancer (HNC). A retrospective case-control study was conducted at our tertiary referral center. Patients with HNC who received oncologic resection followed by autologous free tissue reconstruction were included. Preoperative abdominal computed tomography (CT) imaging was analyzed at the third lumbar vertebra (L3) to calculate skeletal muscle cross-sectional area (CSA, cm2). Skeletal muscle index (SMI, cm2/m2) was calculated by normalizing CSA to patient height. Sarcopenia at L3 was defined as SMI ≤ 41.6 cm2/m2 for males and ≤ 32.0 cm2/m2 for females. Data analyses were performed to compare postoperative outcomes. Of the 168 patients who met inclusion criteria, 47 patients (28.0%) were determined to have preoperative sarcopenia. The sarcopenic group was older (63 vs. 58 years, p = 0.017), had lower body mass index (BMI; 21.2 vs. 27.2, p < 0.001), had greater incidence of alcohol abuse (55.3 vs. 23.1%, OR = 4.11, p < 0.001). Intraoperatively, sarcopenic patients were found to have greater rates of blood transfusions (63.8 vs. 29.8%, p < 0.001). Postoperatively, sarcopenic patients had higher rates of pneumonia (p < 0.01), venous thromboembolism (p < 0.01), prolonged ventilation (p < 0.01), delirium (p < 0.01), fistula (p < 0.05), wound disruption (p < 0.05), and longer intensive care unit stays (p < 0.05). Sarcopenic patients were ultimately found to have higher overall rates of general postoperative complications (p < 0.001) and flap-specific complications (p < 0.01). Sarcopenia was found to be a predictor of postoperative complications in H&N free flap reconstruction, signifying its value as a negative prognostic factor in surgical outcomes. This study reflects level of evidence IV.

The impact of sarcopenia on morbidity and long-term survival among patients with peritoneal metastases of colorectal origin treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a 10-year longitudinal analysis of a single-center experience.

The aim of this study was to evaluate the prognostic value of preoperative sarcopenia with regard to postoperative morbidity and long-term survival in patients with peritoneal metastasis from colorectal cancer treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). A longitudinal cohort study was conducted on patients with peritoneal metastases of colorectal origin treated with CRS-HIPEC between 2008 and 2018. Data on patient demographics, body mass index, operative characteristics, perioperative morbidity and survivorship status and oncological follow-up were obtained from the hospital registry. Sarcopenia was assessed using preoperative computed tomography (CT) findings. Sixty-five patients [mean (SD) age: 54.4 (13.4) years, 64.6% females] were included in the study. Sarcopenia was evident in 30.8% of patients, while mortality rate was 66.2% with median survival time of 33.6months. Presence of sarcopenia was associated with older age (59.6 (9.2) vs. 52.1 (14.4) years, p = 0.038), higher likelihood of morbidity (70.0% vs. 35.6%, p = 0.015) and mortality (90.0% vs. 55.6%, p = 0.010) and shorter survival time (17.7 vs. 37.9months, p = 0.005). Cox regression analysis revealed that the presence of sarcopenia (HR 2.245, 95% CI 0.996-5.067, p = 0.050) was a significant predictor of increased likelihood of mortality. Preoperative sarcopenia is an independent prognostic factor of postoperative morbidity and shorter survival in CRC peritoneal metastasis patients treated with CRS-HIPEC. Our findings support the importance of preoperative screening for sarcopenia as part of preoperative risk assessment for better selection of CRS-HIPEC candidates or treatment modifications in CRC patients with peritoneal metastasis.

Is Preoperative Sarcopenia a Good Predictor of Postoperative Complications and Outcomes after Pelvic Exenteration Surgery?

Background: Sarcopenia is common in oncology patients and has been found to be associated with poorer outcomes after surgery. Pelvic exenteration is a major surgery associated with high rates of morbidity. The aim of this study was to determine if preoperative sarcopenia is associated with postoperative complications and outcomes after pelvic exenteration surgery. Methods: A retrospective study was conducted including 64 oncology patients who had undergone pelvic exenteration surgery between August 2015 and January 2018 and had available preoperative lumbar CT images. Skeletal muscle index (SMI) was calculated by analysing CT images using body composition software. Sarcopenia was determined by using previously published SMI sex-specific cut-offs. Preoperative nutritional status, nutritional indicators and other clinical factors were also collected. Results: There was no association between preoperative sarcopenia and outcomes after pelvic exenteration surgery, however, increased weight (p=0.027) and BMI (p=0.025) were associated with a greater number of total complications. Increasing age was also significant (p=0.001) in explaining the greater number of complications. Greater complexity of surgery itself was associated with greater postoperative complications (p=0.014) and increased length of hospital stay (p=0.001). Conclusion: Preoperative sarcopenia, using dichotomous cut-off points, is not sensitive enough to predict postoperative complications and outcomes in oncology patients undergoing pelvic exenteration surgery; however, other preoperative factors such as weight, BMI and age, and the complexity of surgery, do affect outcomes. Assessment tools that incorporate several clinical and physical factors, such as frailty assessments, should be used in future studies to identify risk factors in such major surgeries.

Sarcopenia and Short-Term Outcomes After Esophagectomy: A Meta-analysis.

This meta-analysis aimed to investigate the value of preoperative sarcopenia in predicting complications after esophagectomy. Clinicopathologic characteristics of sarcopenia patients, which may support sarcopenia management, also were studied. This study searched for articles describing an association between sarcopenia and short-term outcomes after esophagectomy using PubMed, EMBASE, and the Cochrane Library. Mantel-Haenszel and inverse variance models were used for the meta-analyses of end points. The meta-analysis included 14 studies comprising a total of 2387 patients. Sarcopenia was significantly associated with advanced age (weighted mean difference [WMD], 3.48; 95% confidence interval [CI], 2.22-4.74), lower body mass index (WMD - 2.22; 95% CI - 2.65 to - 1.79), squamous cell carcinoma (odds ratio [OR], 2.78; 95% CI 1.72-4.47), advanced clinical tumor stage (OR 1.65; 95% CI 1.28-2.15), and neoadjuvant therapy (OR 1.87; 95% CI 1.38-2.53). The sarcopenia patients showed lower preoperative albumin levels (WMD - 0.11; 95% CI - 0.19 to - 0.04) than the nonsarcopenia patients. Sarcopenia was significantly predictive of pneumonia (OR 2.58; 95% CI 1.75-3.81) and overall complications (OR 1.52; 95% CI 1.07-2.15) after esophagectomy. The sarcopenia patients also showed nonsignificant increases in the risks of anastomotic leakage (OR 1.29; 95% CI 0.99-1.67), vocal cord palsy (OR 2.03; 95% CI 0.89-4.64), and major complications (≥ Clavien-Dindo gradeIII; OR 1.30; 95% CI 0.95-1.79) but not increased operation time, blood loss, or mortality. Preoperative sarcopenia assessment showed considerable potential for predicting postoperative complications for esophageal cancer patients. To realize this potential, more effective diagnostic criteria and severity classifications for sarcopenia are warranted.

Clinical impact of postgastrectomy sarcopenia on the prognosis in patients with gastric cancer.

311 Background: There is a lack of research on newly developed sarcopenia postoperatively. The purpose of this study was to investigate the risk factors and the clinical impact of postgastrectomy sarcopenia on the prognosis in patients undergoing radical gastrectomy for gastric cancer (GC). Methods: We retrospectively reviewed clinicopathological data from 430 consecutive GC patients who underwent surgical resection at Chung-Ang University Hospital between January 2011 and December 2015. Their skeletal muscle mass and abdominal fat volume were measured by abdominal CT imaging. Results: A total of 425 patients were analyzed in the study. The mean age was 62 years old and male were 301 (70.8%). Of these, 42 patients (9.9%) were diagnosed as pre-operative sarcopenia. Compared with non-sarcopenic group, pre-operative sarcopenia groups showed more female, higher BMI, less alcoholic, and less smoking. However, there was no significant difference in 5 - year overall survival and disease free survival between the groups (p = 0.836 and p = 0.638, respectively). Among 381 non-sarcopenic patients, 48 patients (12.6%) were diagnosed as newly developed sarcopenia in one year after gastric resection. Compared with non-sarcopenic group, the newly developed sarcopenic group showed more male, more undifferentiated tumor, lower hemoglobin level, less alcoholic, less smoking, and presence of diabetes mellitus. However, there was no significant difference in the 5 - year overall survival and disease free survival among non-sarcopenic, sarcopenic, and newly developed sarcopenic groups (p = 0.521 and p = 0.534, respectively). The relationship between preoperative body fat volume and postoperative muscle mass showed a significant correlation (rho = 0.296, p &lt; 0.001), but only BMI was significantly associated with long term survival. Conclusions: Although newly developed sarcopenia after surgery did not affect the survival rate, patients with nutritional risk of sarcopenia after surgical resection may require early evaluation of nutritional status and nutritional support.

Preoperative sarcopenia is associated with late mortality after off-pump coronary artery bypass grafting.

We investigated the association between sarcopenia (a marker of frailty) and outcomes after coronary artery bypass grafting (CABG). This study included 304 patients who underwent elective isolated off-pump CABG at our hospital between October 2008 and August 2013. Psoas muscle area was measured on preoperative computed tomography scans. Sarcopenia was defined as the lowest sex-specific quartile of the psoas muscle area index (the psoas muscle area normalized for height). Patients were categorized into a sarcopenia group (76 patients) and a non-sarcopenia group (228 patients). Patients in the sarcopenia group were older and showed a lower body mass index, lower serum haemoglobin and albumin levels and lower prevalence of dyslipidaemia but higher prevalence of renal dysfunction and peripheral artery disease. The mean follow-up period was 4.5 ± 2.3 years. The cut-off values for sarcopenia were psoas muscle area index 215 and 142 mm2/m2 in men and women, respectively. No intergroup difference was observed in the in-hospital mortality and morbidity rates. After risk adjustment using inverse probability weighting analysis, late mortality rates were significantly higher in the sarcopenia group than in the non-sarcopenia group (P = 0.022). Multivariable analysis showed that preoperative sarcopenia was an independent predictor of late mortality (hazard ratio 4.25, 95% confidence interval 2.18-8.28; P < 0.001). Preoperative sarcopenia was not associated with major adverse cardiac and cerebrovascular events during follow-up. Preoperative sarcopenia (assessed by psoas muscle area index) was associated with late mortality after CABG and effectively predicts postoperative prognosis.

Impact of Preoperative Skeletal Muscle Mass and Quality on the Survival of Elderly Patients After Curative Resection of Colorectal Cancer.

Objective: Skeletal muscle loss (sarcopenia) is a prognostic factor in patients undergoing gastrointestinal surgery. However, the influence of muscle quality on prognosis remains unclear. We retrospectively examined preoperative skeletal muscle quantity and quality impact on survival of elderly patients undergoing curative resection of colorectal cancer. Methods: We examined data from 142 patients aged ≥75 years who underwent curative resection of colorectal cancer between 2007 and 2012. We determined the size and quality of skeletal muscles, represented by the psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), respectively, using a preoperative computed tomography image. Overall survival (OS) and relapse-free survival (RFS) rates were determined according to values of PMI, IMAC, and other prognostic factors. Results: OS and RFS rates in patients with low PMI were lower than those in patients with normal PMI. The OS and RFS rates in patients with high IMAC were also lower than those in patients with normal IMAC. PMI and IMAC were independent prognostic factors for OS (hazard ratio [HR], 3.81, and 3.04, respectively); IMAC was an independent factor for RFS (hazard ratio [HR], 3.03). Conclusion: Preoperative sarcopenia, indicating low quality and size of skeletal muscle, predicts mortality after curative resection of colorectal cancer in the elderly.

Skeletal Muscle Loss After Esophagectomy Is an Independent Risk Factor for Patients with Esophageal Cancer.

Postoperative changes in skeletal muscle and their influence on outcomes after esophagectomy for patients with esophageal cancer have not been fully investigated. This study aimed to confirm that postoperative skeletal muscle decrease influences long-term patient outcomes. Data were collected from 218 patients who underwent curative esophagectomy for esophageal cancer whose data were available before and 6months after surgery. The skeletal muscle index (SMI) was measured at the level of the L3 vertebrae, and the postoperative change in the SMI compared with preoperative values was calculated as the delta SMI. The mean SMI value was - 11.64%, and the median delta SMI value was - 11.88%. The first and third quartiles were defined as cutoffs, and 218 patients were classified as the mild-loss group (54 patients), moderate-loss group (110 patients), and severe-loss group (54 patients). The patients with a more severely reduced SMI had a worse prognosis (5-year overall survival rates: mild loss, 66.6%; moderate loss, 58.8%; and severe loss, 48.5%; p = 0.0314). This correlation between reduced SMI and prognosis also was observed for the patients with preoperative sarcopenia (p < 0.0001), but not for those without preoperative sarcopenia. Postoperative reduced SMI and worse prognosis were significantly associated in esophageal cancer patients.

Characteristics of sarcopenia after distal gastrectomy in elderly patients.

Presence of preoperative sarcopenia is a risk factor for postoperative complications. However, there are few reports on the presence of sarcopenia and its characteristics following gastrectomy. Sarcopenia is closely related to quality of life in elderly people. To date, the main purpose of follow-up after gastrectomy is surveillance for early detection of recurrence and secondary cancer. However, henceforth, quality of life in elderly gastric cancer patients after gastrectomy must also be evaluated. The present study aimed to investigate sarcopenia during a 1-year postoperative course in elderly gastric cancer patients and examine their characteristics. The subjects were 50 patients aged ≥70 years who underwent laparoscopy-assisted distal gastrectomy for gastric cancer and who experienced no recurrence 1 year postoperatively. Height, weight, serum albumin levels, food intake amount, grip strength, gait speed, visceral fat area, and appendicular skeletal muscle mass index were measured preoperatively and 6 months and 1 year postoperatively. Sarcopenia, obesity, and visceral obesity were diagnosed. Compared with preoperatively, indicators other than height decreased 6 months postoperatively. Compared with 6 months postoperatively, body weight, amount of food intake, and visceral fat area increased by 1 year postoperatively, unlike appendicular skeletal muscle mass index. The frequency of sarcopenia increased 6 months postoperatively compared with preoperatively; this frequency remained almost unchanged 1 year postoperatively compared with 6 months postoperatively. Further, the frequency of visceral obesity increased 1 year postoperatively compared with 6 months postoperatively. Weight increased after > 6 months postoperatively; however, most of the weight increase was in terms of fat and not muscle. We emphasize the importance of considering postoperative sarcopenia and visceral obesity. In particular, sarcopenia and visceral obesity should be carefully monitored after increases in body mass index and food consumption.

SUN-PO106: Preoperative Sarcopenia and Lymphopenia have an Additive Value for Prognosis Prediction in Localized Pancreatic Ductal Adenocarcinoma

SUN-PO106: Preoperative Sarcopenia and Lymphopenia have an Additive Value for Prognosis Prediction in Localized Pancreatic Ductal Adenocarcinoma

SUN-PO095: Evaluation of Preoperative Sarcopenia in Patients Undergoing Surgery for Gastrointestinal System Cancer

SUN-PO095: Evaluation of Preoperative Sarcopenia in Patients Undergoing Surgery for Gastrointestinal System Cancer

SUN-PO308: Clinical Impact of Preoperative Sarcopenia on Postoperative Nutritional Status in Patients with Hepatobiliary and Pancreas Malignancy

SUN-PO308: Clinical Impact of Preoperative Sarcopenia on Postoperative Nutritional Status in Patients with Hepatobiliary and Pancreas Malignancy

Effect of progressive sarcopenia during postoperative 6 months on long-term prognosis of completely resected lung cancer.

Preoperative sarcopenia has been indicated to be a potential prognostic factor for patients after complete resection of lung cancer. This study evaluated whether changes in the skeletal muscle mass index (SMI) over postoperative 6 months could predict long-term prognosis from 6 months after complete resection of non-small cell lung cancer (NSCLC). This retrospective study analyzed data of 468 patients who underwent curative lobar resection for non-small cell lung cancer at our hospital. The 6-month postoperative change in SMI was calculated, and associations between clinicopathological factors (including the change in SMI) and postoperative mortality were examined. Rates of overall survival were 90.6% after 3 years and 80.7% after 5 years. The median 6-month change in SMI was -3.4% (range, -22.3% to 14.7%). Multivariate analysis revealed that poor outcomes were independently predicted by a large change in SMI, age, pathological stage, lymphovascular invasion, and a Brinkman index of ≥600. Through the analysis in training and validation sets, we determined a cut-off value of -9.9% for the 6-month postoperative change in SMI. Subgroup analysis showed that depletion of SMI during postoperative 6 months was a risk factor for poorer prognosis only in heavy smokers with a Brinkman index of ≥600. A reduction in SMI during the 6 months after complete resection of non-small cell lung cancer significantly predicted prognosis, especially in heavy smokers. These results suggest that attention should be given to prevent the perioperative progression of sarcopenia after curative resection of lung cancer. Thoracic surgeons should take how to manage perioperatively against sarcopenia into consideration.

Impact and risk factors for clinically relevant surgery-related muscle loss in patients after major abdominal cancer surgery: study protocol for a prospective observational cohort study (MUSCLE POWER)

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Surgery-related muscle loss (SRML) occurs in at least one out of three cancer patients within one week after major surgery. Though, this important phenomenon has hardly been investigated.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The MUSCLE POWER is a prospective, observational cohort study that investigates the presence, impact, and predictors for clinically relevant SRML in 178 cancer patients after major abdominal surgery using ultrasound measurements, squeeze and force measurements, and QoL questionnaires. Primary endpoint is the proportion of patients with clinically relevant SRML defined as ≥5% muscle loss within one week after surgery, measured by the cross-sectional area (CSA) of three different muscles: m. biceps brachii, m. rectus femoris, and m. vastus intermedius. Possible correlation with QoL and fatigue up to six months after surgery will be investigated. Daily physical activity during hospital stay will be monitored by a motility tracker, and protein intake will be monitored by a dietician. Possible predictors for clinically relevant SRML—consisting of age ≥65 years, preoperative diabetes, preoperative sarcopenia, major postoperative complications (Clavien-Dindo ≥III), insufficient physical activity, and insufficient postoperative protein intake—will be investigated with a multivariable logistic regression analyses with a backward stepwise approach. Variables with a &lt;em&gt;p&lt;/em&gt;&amp;lt;0.05 will be retrained in the final multivariable model.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The MUSCLE POWER investigates the presence and impact of clinically relevant SRML in cancer patients after major abdominal surgery. Crucial information regarding possible predictors for clinically relevant SRML can be used in future intervention studies to prevent postoperative muscle loss and subsequently improve postoperative outcome and QoL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial Registration: &lt;/strong&gt;Medical Ethics Committee of the University Medical Center Groningen, the Netherlands (METc2018/361, version 3.0, January 21, 2019), and Netherlands Trial Register ([NTR], NTR NL7505, version 1.0, February 7, 2019).&lt;/p&gt;

Prognostic Significance of Skeletal Muscle Loss During Early Postoperative Period in Elderly Patients with Esophageal Cancer.

Skeletal muscle loss during the early postoperative period frequently occurs during post-esophagectomy. Preoperative sarcopenia is a known prognostic factor. However, the prognostic significance of postoperative skeletal muscle loss remains unclear. This study was designed to clarify the impact of skeletal muscle loss during the early postoperative period on the prognosis of elderly patients undergoing esophagectomy. We included 316 patients (age ≥ 65years) who underwent esophagectomy. The skeletal muscle index (SMI) at the third lumber vertebra's bottom level was measured using computed tomography (CT) before surgery and 4months after surgery. The SMI reduction rate, patient's prognosis, and recurrence rates were evaluated. The SMI reduction rates in tertiles were < 1.25% in the first tertile (t1, n = 105), between 1.25 and 9.13% in the second tertile (t2, n = 106), and > 9.13% in the third tertile (t3, n = 105). Both relapse-free survival (RFS) and overall survival (OS) in t3 were significantly worse than those in t1 and t2 (p < 0.001). Therefore, we defined t3 as the massive reduction (MR) group and t1 and t2 as the limited reduction (LR) group. By univariate analysis, both RFS and OS were significantly poorer in the MR group than in LR. By multivariate analysis, the massive skeletal muscle loss during the early postoperative period was an independent factor for both RFS and OS. Early postoperative skeletal muscle loss predicts both recurrence and poor survival.

Effects of preoperative sarcopenia on postoperative complications of minimally invasive oesophagectomy for oesophageal squamous cell carcinoma.

Sarcopenia is closely associated with surgical complications in patients with certain cancers. In this study we assessed the relationship between sarcopenia and postoperative complications in patients with oesophageal squamous cell carcinoma. We retrospectively analysed of patients who underwent thoracoscopic combined with laparoscopic radical resection of oesophageal cancer. Preoperative computed tomography to evaluate skeletal muscle mass to diagnose sarcopenia and to evaluate associations with age, body mass index (BMI), lung function and postoperative complications. Among 141 patients, 73 presented with sarcopenia (sarcopenia group) and 68 did not (non-sarcopenia group). The mean skeletal muscle index in all patients was 49.5±9.0 cm2/m2; median, 49.3 cm2/m2. The sarcopenia group included a higher proportion of men (P=0.039) and had a lower BMI than the non-sarcopenia group (P=0.001). There were no significant differences in any other clinical and pathological features. The incidences of postoperative complications in the sarcopenia and non-sarcopenia groups were 63.0% and 36.8%, respectively (P=0.002). The incidences of pulmonary infections and postoperative pleural effusions were 28.8% vs. 11.8% (P=0.011) and 38.4% vs. 20.6% (P=0.020) in the sarcopenia and non-sarcopenia groups, respectively. The incidences of other complications were not significantly different between the two groups. Univariate and multivariate analyses of pulmonary infection-related clinical factors revealed that sarcopenia and forced expiratory volume in the first second as a percent of forced vital capacity (FEV1.0%) were independent risk factors for pulmonary infection after minimally invasive surgery. Preoperative sarcopenia is an independent risk factor for pulmonary infection after minimally invasive oesophagectomy (MIE). Evaluation of preoperative sarcopenia will thus help to prevent postoperative complications.

The psoas muscle index as a predictor of long-term survival after cardiac surgery for hemodialysis-dependent patients.

Sarcopenia represented by skeletal muscle depletion is closely related to frailty and predicts prognoses in the general population. However, its predictive value for hemodialysis (HD)-dependent patients undergoing cardiac surgery has not been fully investigated. We aimed to clarify the impact of sarcopenia on the outcomes of HD-dependent patients after cardiac surgery. We retrospectively reviewed 138 HD-dependent patients who underwent cardiac surgery between January 2006 and December 2017. Sarcopenia was assessed using the psoas muscle index (PMI), which was calculated using values measured on preoperative computed tomography images and the following formula: cross-sectional area of bilateral psoas muscle/height2. Patients were divided into two groups according to the PMI: the sarcopenia group (≤ 443mm2/m2 for men and ≤ 326mm2/m2 for women; n = 35) and the non-sarcopenia group (> 443mm2/m2 for men and > 326mm2/m2 for women; n = 103). Preoperative characteristics and surgical outcomes were compared. Overall in-hospital mortality did not differ between the sarcopenia and non-sarcopenia groups. However, the patients with sarcopenia had significantly decreased long-term survival. Multivariate analysis revealed that low PMI was a significant independent predictor of long-term mortality (hazard ratio, 1.92; 95% confidential interval, 1.19-3.17; p < 0.01). Long-term survival rates in HD-dependent patients undergoing cardiac surgery are severely affected by the presence of preoperative sarcopenia defined by PMI. Preoperative risk analysis using the PMI might contribute to risk stratification of and decision-making for HD-dependent patients undergoing cardiac surgery.

194 – Pre-Operative Sarcopenia Predicts Low Islet Cell Yield Following Total Pancreatectomy with Islet Autotransplantation (TPIAT) for Chronic Pancreatitis (CP)

194 – Pre-Operative Sarcopenia Predicts Low Islet Cell Yield Following Total Pancreatectomy with Islet Autotransplantation (TPIAT) for Chronic Pancreatitis (CP)

Prognostic Value and Association of Sarcopenia and Systemic Inflammation for Patients with Gastric Cancer Following Radical Gastrectomy.

The aim of this study was to investigate the prognostic value of preoperative sarcopenia and systemic inflammation for patients with resectable gastric cancer (GC) and develop a novel and powerful prognostic score based on these factors. Patients with GC who underwent radical gastrectomy between December 2009 and December 2013 were included. A multivariate Cox regression analysis was performed to identify the prognostic factors. A novel prognostic score (SLMR) was developed based on preoperative sarcopenia and the lymphocyte-monocyte ratio (LMR), and its prognostic value was evaluated. In total, 1,167 patients with resectable GC were included in the study. On multivariate analysis, preoperative sarcopenia and the LMR were shown to be independent prognostic factors (both p < .001). A low LMR was an independent predictor from sarcopenia (p < .001). Based on preoperative sarcopenia and the LMR, we established the SLMR. An elevated SLMR was associated with older age, higher ASA scores, larger tumor size, advanced stages, and vascular invasion (all p < .05). Multivariate analysis revealed that the SLMR was a significant independent predictor (p < .001). We incorporated the SLMR into a prognostic model that included tumor size and TNM stage and generated a nomogram, which accurately predicted 3- and 5-year survival for GC patients. Preoperative systemic inflammation is significantly associated with sarcopenia. The LMR combined with sarcopenia could enhance prognostication for patients with GC who underwent radical gastrectomy. Increasing evidence shows that sarcopenia and systemic inflammation are closely associated with the prognosis of malignant tumors, and it is essential for clinicians to understand the relationship and combined prognostic effects of these factors for gastric cancer (GC). Based on a large data set, this study found that preoperative systemic inflammation was significantly associated with sarcopenia in GC, and combining these two predictors could effectively predict the prognosis and complement the prognostic value of the TNM staging system. These findings may lead to the development of new therapeutic avenues to improve cancer outcomes.