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Onuma T, Kamishima T, Shimamura T, Kawamura N, Yamashita K, Sutherland K, Takeda H. Longitudinal CT study of sarcopenia due to hepatic failure after living donor liver transplantation. Quant Imaging Med Surg 2018. [PMID: 29541620 DOI: 10.21037/qims.2018.01.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The quantity and quality of skeletal muscle have been observed to be closely related with post-transplantation mortality in patients undergoing living donor liver transplantation (LDLT). However, the effect of LDLT on skeletal muscle has not been thoroughly investigated. The aim of this study was to investigate the change of trunk muscle mass and adiposity in recipients of LDLT. Methods The study population included LDLT recipients at Hokkaido University Hospital who underwent pre- and post-operative computed tomography (CT) scans (31 recipients; 14 males, and 17 females). The cross-sectional area of the dorsal muscle group at the 12th thoracic vertebra (Th12) was measured with the dorsal muscle group mass index (DMGMI), while the psoas muscle at the upper border of 4th lumber vertebra (L4) was measured with the psoas muscle mass index (PMI). Muscle adiposity of the dorsal muscle group was also measured with the intramuscular adipose tissue content (IMAC). For these data, the correlation between pre-operative values and follow-up changes (post-operative values minus pre-operative values) were analyzed. Each sex was evaluated separately. Results A statistically significant correlation was detected between pre-operative values and follow-up differences in DMGMI for both sexes (male: r=-0.675, P=0.008; female: r=-0.687, P=0.002) and in PMI for both sexes (males: r=-0.739, P=0.003; females: r=-0.641, P=0.006). The correlation of pre-operative values and follow-up differences for IMAC was not statistically significant with r=0.132 (P=0.700) and r=-0.498 (P=0.071) for males and females, respectively. Conclusions Improvement of sarcopenia in recipients of LDLT can be demonstrated regardless of sex using volumetric CT.
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Affiliation(s)
- Takahiro Onuma
- Department of Radiology, National Hospital Organization Hokkaido Medical Center, Sapporo, Hokkaido, Japan
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tsuyoshi Shimamura
- Department of Organ Transplantation, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Norio Kawamura
- Department of Gastroenterological Surgery 1, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kenichiro Yamashita
- Department of Transplant Surgery, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kenneth Sutherland
- Global Station for Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido, Japan
| | - Hiroshi Takeda
- Department of Pathophysiology and Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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Jin WH, Mellon EA, Frakes JM, Murimwa GZ, Hodul PJ, Pimiento JM, Malafa MP, Hoffe SE. Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy. J Gastrointest Oncol 2018; 9:24-34. [PMID: 29564168 DOI: 10.21037/jgo.2017.09.13] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Total psoas area (TPA), a marker of sarcopenia, has been used as an independent predictor of clinical outcomes in gastrointestinal (GI) cancers as a proxy for frailty and nutritional status. Our study aimed to evaluate whether TPA, in contrast to traditional measurements of nutrition like body mass index (BMI) and body surface area (BSA), was predictive of outcomes in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients receiving stereotactic body radiation therapy (SBRT). Methods Retrospective analysis of an institutional review board approved database of 222 BRPC and LAPC treated with SBRT from 2009-2016 yielded 183 patients that met our selection criteria of pre-SBRT computed tomography (CT) imaging with an identifiable L4 vertebra. Once the L4 vertebral level was identified, the bilateral psoas muscles were manually contoured. This area was normalized by patient height, with units described in mm2/m2. Receiver operating characteristic (ROC) curves were generated for TPA, BMI, and BSA to elicit clinically relevant cutoffs. Regression and Kaplan-Meier analyses were used to correlate toxicity with survival functions. Results Low TPA (OR =1.903, P=0.036) was predictive of acute toxicities, and only TPA was predictive of Grade 3 or higher acute toxicities (OR =10.24, P=0.007). Both findings were independent of tumor resectability. Pain (P=0.003), fatigue (P=0.040), and nausea (P=0.039) were significantly associated with low TPA. No association was identified between any measurement of nutritional status and the development of late toxicities, overall survival, local progression or local recurrence. However, BRPC patients survived longer (median =21.98 months) than their LAPC (median =16.2 months) counterparts (P=0.002), independent of nutritional status. Conclusions TPA measurement is readily available and more specific than BMI or BSA as a predictor of acute radiotoxic complications following SBRT in BRPC/LAPC patients. A TPA of <500 mm2/m2 is a clinically relevant cutoff that can direct physicians to address expected complications of pain, fatigue, and nausea. However, tumor resectability remains as the only predictor of overall survival in this cohort.
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Affiliation(s)
- William H Jin
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Moffitt Cancer Center, Tampa, FL, USA
| | | | | | - Gilbert Z Murimwa
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Moffitt Cancer Center, Tampa, FL, USA
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Early nutritional inadequacy is associated with psoas muscle deterioration and worse clinical outcomes in critically ill surgical patients. J Crit Care 2018; 45:7-13. [PMID: 29360610 DOI: 10.1016/j.jcrc.2017.12.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 12/11/2017] [Accepted: 12/30/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To explore whether psoas cross sectional area (CSA) and density (Hounsfield Units, HU) are associated with nutritional adequacy and clinical outcomes in surgical intensive care unit patients. MATERIALS AND METHODS Subjects with at least one CT scan within 72h of ICU admission were included. Demographic, nutritional, radiographic, and outcomes data were collected. Psoas muscle CSA and HU were assessed at the L4-L5 intervertebral disk level. Change (Δ) in CSA and HU overall and per day were calculated. RESULTS 140 patients were included. There was no significant correlation between baseline CSA and HU and clinical outcomes. Patients with at least two CT scans (n=65), had a median decrease in CSA of -15% [IQR: -20%, -8%] and decrease in HU of -2% [IQR: -30%, +24%]. Patients with the greatest daily %HU decline received significantly fewer calories/kg and proteins/kg and accumulated greater protein deficits at day 7 and overall. Patients with daily %HU increase had the shortest ICU and hospital LOS and more ventilator-free days in univariate and multivariable analyses. CONCLUSIONS In this exploratory study, early nutritional deficits were correlated with muscle quality deterioration. Inpatient gain in psoas density, compared to maintenance or loss, is associated with shorter hospital stay.
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154
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Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery. J Trauma Acute Care Surg 2017; 83:1179-1186. [PMID: 28777289 DOI: 10.1097/ta.0000000000001657] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. METHODS Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. RESULTS Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p < 0.05). Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). CONCLUSION Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is a simple and objective measure of frailty that identifies vulnerable patients for improved preoperative counseling, setting realistic goals of care, and consideration of less invasive approaches. LEVEL OF EVIDENCE Prognostic study, level III.
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Namm JP, Thakrar KH, Wang CH, Stocker SJ, Sur MD, Berlin J, Dale W, Talamonti MS, Roggin KK. A semi-automated assessment of sarcopenia using psoas area and density predicts outcomes after pancreaticoduodenectomy for pancreatic malignancy. J Gastrointest Oncol 2017; 8:936-944. [PMID: 29299352 PMCID: PMC5750184 DOI: 10.21037/jgo.2017.08.09] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/08/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Sarcopenia has been associated with increased adverse outcomes after major abdominal surgery. Sarcopenia defined as decreased muscle volume or increased fatty infiltration may be a proxy for frailty. In conjunction with other preoperative clinical risk factors, radiographic measures of sarcopenia using both muscle size and density may enhance prediction of outcomes after pancreaticoduodenectomy (PD) for malignancy. METHODS Preoperative computed tomography (CT) scans of patients undergoing PD for malignancy were analyzed from a prospective pancreatic surgery database. Sarcopenia was assessed both manually and with a semi-automated technique by measuring the total psoas area index (TPAI) and average Hounsfield units (HU) at the L3 lumbar level to estimate psoas muscle volume and density, respectively. Adjusting for known pre-operative risk factors, preoperative sarcopenia measurements were analyzed relative to perioperative outcomes. RESULTS Sarcopenia assessments of 116 subjects demonstrated good correlation between the semi-automated and the manual techniques (P<0.0001). Lower TPAI (OR 0.34, P=0.009) and HU (OR 0.84, P=0.002) measurements were predictive of discharge to skilled nursing facility (SNF), but not major complications, length of stay, readmissions or recurrence on univariate analysis. Lower TPAI was protective against the risk of organ/space surgical site infection (SSI) including pancreatic fistula (OR 3.12, P=0.019). On multivariate analysis, the semi-automated measurements of TPAI and HU remained as independent predictors of organ/space SSI including pancreatic fistula (OR 4.23, P=0.014) and discharge to SNF (OR 0.79, P=0.019) respectively. CONCLUSIONS When combined with preoperative clinical assessments in patients with pancreatic malignancy, semi-automated sarcopenia metrics are a simple, reproducible method that may enhance prediction of outcomes after PD and help guide clinical management.
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Affiliation(s)
- Jukes P. Namm
- Department of Surgery, Loma Linda University Health, Loma Linda, USA
| | - Kiran H. Thakrar
- Department of Radiology, NorthShore University HealthSystem, Evanston, USA
| | - Chi-Hsiung Wang
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, USA
| | - Susan J. Stocker
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - Malini D. Sur
- Department of Surgery, Mount Sinai Health System, New York, USA
| | - Jonathan Berlin
- Department of Radiology, NorthShore University HealthSystem, Evanston, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, California, USA
| | - Mark S. Talamonti
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - Kevin K. Roggin
- Department of Surgery, The University of Chicago Medicine, Chicago, USA
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156
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Do psoas muscle area and volume correlate with postoperative complications in patients undergoing rectal cancer resection? Am J Surg 2017; 215:503-506. [PMID: 29277239 DOI: 10.1016/j.amjsurg.2017.10.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasingly, patients with multiple co-morbidities undergo surgery for rectal cancer. We aimed to evaluate if decreased psoas muscle area and volume, as measures for sarcopenia, were associated with postoperative morbidity. METHODS Retrospective review of patients undergoing rectal cancer resection at a tertiary medical center (2007-2015). Variables included demographics, co-morbidities, preoperative psoas muscle area and volume, and postoperative complications. RESULTS Among 180 patients (58% male, mean age 62.7 years), 44% experienced complications (n = 79), of which 38% (n = 30) were major complications. Malnourished patients had smaller height-adjusted total psoas area than non-malnourished patients (6.4 vs. 9.5 cm2/m2, p = 0.004). Among patients with imaging obtained within 90 days of surgery, major morbidity was associated with smaller total psoas area (6.7 vs. 10.5 cm2/m2, p = 0.04) and total psoas volume (26.7 vs. 42.2 cm3/m2, p = 0.04) compared to those with minor complications. CONCLUSION Preoperative cross-sectional imaging may help surgeons anticipate postoperative complications following rectal cancer surgery.
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157
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Significance of sarcopenia as a prognostic factor for metastatic urothelial carcinoma patients treated with systemic chemotherapy. Int J Clin Oncol 2017; 23:338-346. [PMID: 29098519 DOI: 10.1007/s10147-017-1207-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/24/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recently, numerous studies have reported an association between sarcopenia and poor outcomes in various kinds of malignancies. We investigated whether sarcopenia predicts the survival of patients with metastatic urothelial carcinoma who underwent systemic chemotherapy. METHODS We reviewed 87 metastatic urothelial carcinoma patients who underwent chemotherapy (gemcitabine plus cisplatin or gemcitabine plus carboplatin for cisplatin-unfit patients) between 2007 and 2015. A computed tomography scan prior to chemotherapy was used for evaluating sarcopenia, and we measured three cross-sectional areas of skeletal muscle at the third lumbar vertebra and calculated the skeletal muscle index (SMI), the paraspinal muscle index (PSMI), and the total psoas area (TPA) of each patient. Predictive values of survival were assessed using Cox regression analysis. RESULTS The median overall survival (OS) was 16 months (95% CI 13.5-18). Although SMI alone was not a significant predictor of shorter OS (P = 0.117) in univariate analysis, SMI stratified by the value of the body mass index (BMI) was a significant predictor of shorter OS in univariate analysis (P = 0.037) and was also an independent predictor of shorter OS in multivariate analysis (P = 0.026). PSMI and TPA were not significant prognostic factors even when stratified by BMI (P = 0.294 and 0.448), respectively. CONCLUSION Neither PSMI nor TPA could substitute SMI as a predictor for poor outcomes in metastatic urothelial carcinoma patients treated with systemic chemotherapy in our study. SMI stratified by BMI is a useful predictor of prognosis in these patients.
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158
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Clinical Outcomes of Living Liver Transplantation According to the Presence of Sarcopenia as Defined by Skeletal Muscle Mass, Hand Grip, and Gait Speed. Transplant Proc 2017; 49:2144-2152. [DOI: 10.1016/j.transproceed.2017.09.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/10/2017] [Accepted: 09/23/2017] [Indexed: 02/07/2023]
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Malekpour M, Bridgham K, Jaap K, Erwin R, Widom K, Rapp M, Leonard D, Baro S, Dove J, Hunsinger M, Blansfield J, Shabahang M, Torres D, Wild J. The Effect of Sarcopenia on Outcomes in Geriatric Blunt Trauma. Am Surg 2017. [DOI: 10.1177/000313481708301120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Elderly patients are at a higher risk of morbidity and mortality after trauma, which is reflected through higher frailty indices. Data collection using existing frailty indices is often not possible because of brain injury, dementia, or inability to communicate with the patient. Sarcopenia is a reliable objective measure for frailty that can be readily assessed in CT imaging. In this study, we aimed to evaluate the effect of sarcopenia on the outcomes of geriatric blunt trauma patients. Left psoas area (LPA) was measured at the level of the third lumbar vertebra on the axial CT images. LPA was normalized for height (LPA mm2/m2) and after stratification by gender, sarcopenia was defined as LPA measurements in the lowest quartile. A total of 1175 patients consisting of 597 males and 578 females were studied. LPAs below 242.6 mm2/m2 in males and below 187.8 mm2/m2 in females were considered to be sarcopenic. We found sarcopenia in 149 males and 145 females. In multivariate analysis, sarcopenia was associated with a higher risk of in-hospital mortality (odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.01–2.56) and a higher risk of discharge to less favorable destinations (OR: 1.42, 95% CI: 1.05–1.97). Lastly, sarcopenic patients had an increased risk of prolonged hospitalization (hazard ratio: 1.21, 95% CI: 1.04–1.40).
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Affiliation(s)
- Mahdi Malekpour
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Kelly Bridgham
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Kathryn Jaap
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Ryan Erwin
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Kenneth Widom
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Megan Rapp
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Diane Leonard
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Susan Baro
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - James Dove
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Marie Hunsinger
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Joseph Blansfield
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Mohsen Shabahang
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Denise Torres
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey Wild
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Ishii N, Iwata Y, Nishikawa H, Enomoto H, Aizawa N, Ishii A, Miyamoto Y, Yuri Y, Hasegawa K, Nakano C, Nishimura T, Yoh K, Sakai Y, Ikeda N, Takashima T, Takata R, Iijima H, Nishiguchi S. Effect of pretreatment psoas muscle mass on survival for patients with unresectable pancreatic cancer undergoing systemic chemotherapy. Oncol Lett 2017; 14:6059-6065. [PMID: 29113246 DOI: 10.3892/ol.2017.6952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/04/2017] [Indexed: 12/18/2022] Open
Abstract
To the best of our knowledge, there are few previous studies that have investigated the effect of decreased skeletal muscle mass (DSMM) on survival in patients with unresectable advanced pancreatic cancer (APC) who are undergoing systemic chemotherapy. Thus, the present study aimed to investigate the impact of DSMM, as determined by the psoas muscle index (PMI) following computed tomography and prior to systemic chemotherapy, on the outcomes of patients with unresectable APC (n=61). The primary endpoint used was the overall survival (OS) rate. The OS rates in the PMI-High group (exceeds the median PMI value in each gender) were retrospectively compared with those in the PMI-Low group (below the median PMI value in each gender), and factors associated with OS were investigated using univariate and multivariate analyses. The study cohort included 31 male and 30 female patients with a median age of 72 years, 13 of whom were stage IVA, and 48 were stage IVB. The median PMI in males was 4.3 cm2/m2 (range, 1.6-8.2 cm2/m2), while that in females was 2.3 cm2/m2 (range, 0.7-6.1 cm2/m2). The proportion of patients with performance status 0 in the PMI-High group was significantly high, compared with that in the PMI-Low group [83.3% (25/30) vs. 58.1% (18/31); P=0.0486]. Body mass index in the PMI-High group was significantly higher compared with that in the PMI-Low group (P=0.0154). The 1-year cumulative survival rate was 43.3% in the PMI-High group and 12.9% in the PMI-Low group (P=0.0027). Following multivariate analysis, PMI (P=0.0036), prothrombin time (P=0.0044) and carbohydrate antigen 19-9 (P=0.0451) were identified to be significant predictors of OS. In conclusion, DSMM, as determined by the PMI, could be a significant predictor of prognosis in patients with unresectable APC who are receiving systemic chemotherapy.
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Affiliation(s)
- Noriko Ishii
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Yoshinori Iwata
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Hiroki Nishikawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Hirayuki Enomoto
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Nobuhiro Aizawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Akio Ishii
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Yuho Miyamoto
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Yukihisa Yuri
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Kunihiro Hasegawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Chikage Nakano
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Takashi Nishimura
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Kazunori Yoh
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Yoshiyuki Sakai
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Naoto Ikeda
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Tomoyuki Takashima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Ryo Takata
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
| | - Shuhei Nishiguchi
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiyashi, Hyogo 663-8501, Japan
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Ethun CG, Bilen MA, Jani AB, Maithel SK, Ogan K, Master VA. Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA Cancer J Clin 2017; 67:362-377. [PMID: 28731537 DOI: 10.3322/caac.21406] [Citation(s) in RCA: 343] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Answer questions and earn CME/CNE The concept of frailty has become increasingly recognized as one of the most important issues in health care and health outcomes and is of particular importance in patients with cancer who are receiving treatment with surgery, chemotherapy, and radiotherapy. Because both cancer itself, as well as the therapies offered, can be significant additional stressors that challenge a patient's physiologic reserve, the incidence of frailty in older patients with cancer is especially high-it is estimated that over one-half of older patients with cancer have frailty or prefrailty. Defining frailty can be challenging, however. Put simply, frailty is a state of extreme vulnerability to stressors that leads to adverse health outcomes. In reality, frailty is a complex, multidimensional, and cyclical state of diminished physiologic reserve that results in decreased resiliency and adaptive capacity and increased vulnerability to stressors. In addition, over 70 different measures of frailty have been proposed. Still, it has been demonstrated that frail patients are at increased risk of postoperative complications, chemotherapy intolerance, disease progression, and death. Although international standardization of frailty cutoff points are needed, continued efforts by oncology physicians and surgeons to identify frailty and promote multidisciplinary decision making will help to develop more individualized management strategies and optimize care for patients with cancer. CA Cancer J Clin 2017;67:362-377. © 2017 American Cancer Society.
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Affiliation(s)
- Cecilia G Ethun
- General Surgery Resident, Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mehmet A Bilen
- Assistant Professor, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Ashesh B Jani
- Professor, Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K Maithel
- Associate Professor, Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kenneth Ogan
- Professor of Urology, Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Viraj A Master
- Professor, Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA
- Director of Clinical Research, Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA
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Rutten IJG, Ubachs J, Kruitwagen RFPM, Beets-Tan RGH, Olde Damink SWM, Van Gorp T. Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer. J Cachexia Sarcopenia Muscle 2017; 8:630-638. [PMID: 28513088 PMCID: PMC5566632 DOI: 10.1002/jcsm.12180] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 11/27/2016] [Accepted: 12/08/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Computed tomography measurements of total skeletal muscle area can detect changes and predict overall survival (OS) in patients with advanced ovarian cancer. This study investigates whether assessment of psoas muscle area reflects total muscle area and can be used to assess sarcopenia in ovarian cancer patients. METHODS Ovarian cancer patients (n = 150) treated with induction chemotherapy and interval debulking were enrolled retrospectively in this longitudinal study. Muscle was measured cross sectionally with computed tomography in three ways: (i) software quantification of total skeletal muscle area (SMA); (ii) software quantification of psoas muscle area (PA); and (iii) manual measurement of length and width of the psoas muscle to derive the psoas surface area (PLW). Pearson correlation between the different methods was studied. Patients were divided into two groups based on the extent of change in muscle area, and agreement was measured with kappa coefficients. Cox-regression was used to test predictors for OS. RESULTS Correlation between SMA and both psoas muscle area measurements was poor (r = 0.52 and 0.39 for PA and PLW, respectively). After categorizing patients into muscle loss or gain, kappa agreement was also poor for all comparisons (all κ < 0.40). In regression analysis, SMA loss was predictive of poor OS (hazard ratio 1.698 (95%CI 1.038-2.778), P = 0.035). No relationship with OS was seen for PA or PLW loss. CONCLUSIONS Change in psoas muscle area is not representative of total muscle area change and should not be used to substitute total skeletal muscle to predict survival in patients with ovarian cancer.
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Affiliation(s)
- Iris J G Rutten
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands.,Department of Radiology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands
| | - Jorne Ubachs
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands.,Department of Radiology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,Department of Radiology, Netherlands Cancer Institute, PO Box 90203, Amsterdam, 1006 BE, The Netherlands
| | - Steven W M Olde Damink
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands
| | - Toon Van Gorp
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands
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163
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Maggiore R, Zumsteg ZS, BrintzenhofeSzoc K, Trevino KM, Gajra A, Korc-Grodzicki B, Epstein JB, Bond SM, Parker I, Kish JA, Murphy BA, VanderWalde NA. The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment. Int J Radiat Oncol Biol Phys 2017; 98:868-883. [PMID: 28602414 DOI: 10.1016/j.ijrobp.2017.02.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
Older adults with head and neck squamous cell carcinoma (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced disease, for which combined-modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and a higher risk of functional impairments remains challenging and is exacerbated by the paucity of studies involving older adults. The purpose of this article is to identify knowledge gaps in the evaluation and management of older adults with HNSCC-particularly those undergoing concurrent chemoradiation therapy-and their caregivers through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with locoregionally advanced HNSCC. On the basis of our findings, we prioritize these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.
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Affiliation(s)
- Ronald Maggiore
- Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, New York
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Kelly M Trevino
- Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Ajeet Gajra
- Division of Hematology/Oncology, Department of Medicine, SUNY Upstate Medical University Cancer Center, Syracuse, New York
| | | | - Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stewart M Bond
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Ira Parker
- University of California, San Diego School of Medicine, La Jolla, California
| | - Julie A Kish
- Division of Hematology/Oncology, Department of Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Barbara A Murphy
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Noam A VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center-West Cancer Center, Memphis, Tennessee.
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164
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Pamoukdjian F, Bouillet T, Lévy V, Soussan M, Zelek L, Paillaud E. Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review. Clin Nutr 2017; 37:1101-1113. [PMID: 28734552 DOI: 10.1016/j.clnu.2017.07.010] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/16/2017] [Accepted: 07/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS To assess the prevalence of sarcopenia before cancer treatment and its predictive value during the treatment. METHODS We searched MEDLINE via PubMed for articles published from 2008 to 2016 that reported prospective observational or interventional studies of the prevalence of pre-therapeutic sarcopenia and its consequences in adults with cancer who were 18 years or older. Two independent reviewers selected articles based on titles and/or abstracts before a complete review. Sarcopenia had to be measured before cancer treatment. Methods recommended by consensuses (CT scan, MRI, dual X-ray absorptiometry or bio-impedancemetry) to assess sarcopenia were considered. Characteristics of the studies included the prevalence of pre-therapeutic sarcopenia and the prognostic value for outcomes during the cancer treatment. RESULTS We selected 35 articles involving 6894 participants (in/out patients, clinical trials). The mean age ranged from 53 to 69.6 years. Pre-therapeutic sarcopenia was found in 38.6% of patients [95% CI 37.4-39.8]. Oesophageal and small-cell lung cancers showed the highest prevalence of pre-therapeutic sarcopenia. Pre-therapeutic sarcopenia was significantly and independently associated with post-operative complications, chemotherapy-induced toxicity and poor survival in cancer patients. CONCLUSIONS Pre-therapeutic sarcopenia is highly prevalent in cancer patients and has severe consequences for outcomes of cancer patients.
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Affiliation(s)
- Frédéric Pamoukdjian
- APHP, Avicenne Hospital, Geriatric Department, Coordination Unit in Geriatric Oncology, F-93000, Bobigny, France; Université Paris 13, Sorbonne Paris Cité, Health Education and Practices Laboratory (LEPS EA3412), F-93017, Bobigny, France.
| | - Thierry Bouillet
- APHP, Avicenne Hospital, Department of Medical Oncology, F-93000, Bobigny, France
| | - Vincent Lévy
- APHP, Avicenne Hospital, Clinical Research Unit/Clinical Research Center, F-93000, Bobigny, France
| | - Michael Soussan
- APHP, Avicenne Hospital, Department of Radiology, F-93000, Bobigny, France
| | - Laurent Zelek
- APHP, Avicenne Hospital, Department of Medical Oncology, F-93000, Bobigny, France
| | - Elena Paillaud
- APHP, Henri-Mondor Hospital, Geriatric Department, Geriatric Oncology Unit, F-94000, Créteil, France; Université Paris-Est, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), F-94000, Créteil, France
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165
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Heard RSM, Ramsay G, Hildebrand DR. Sarcopaenia in surgical populations: A review. Surgeon 2017; 15:366-371. [PMID: 28684167 DOI: 10.1016/j.surge.2017.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 02/07/2023]
Abstract
Sarcopaenia, or decreased muscle mass, has been the subject of a large quantity of recent literature in both medical and surgical disciplines. It has been shown, as outlined below, to be of great prognostic importance, and also may be used in certain circumstances to guide treatment. The greatest volume of research into this topic is in oncological surgical populations, in whom the prevalence of sarcopaenia has been shown to be high. However it is being increasingly studied in other patient groups. Interest in using sarcopaenia as an objective and potentially modifiable marker of frailty is increasing, especially with regards to pre-operative risk stratification and amelioration. In this review we consider the current literature regarding the cause and effect of sarcopaenia, the methods by which it may be identified and the potential ways in which it may be treated, in the interest of improving outcomes for surgical patients.
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Affiliation(s)
- Rachel S M Heard
- Department of General Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
| | - George Ramsay
- Department of General Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
| | - Diane R Hildebrand
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
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166
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Can Comprehensive Imaging Analysis with Analytic Morphomics and Geriatric Assessment Predict Serious Complications in Patients Undergoing Pancreatic Surgery? J Gastrointest Surg 2017; 21:1009-1016. [PMID: 28342121 DOI: 10.1007/s11605-017-3392-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/03/2017] [Indexed: 01/31/2023]
Abstract
We aimed to determine whether comprehensive imaging analysis with analytic morphomics (AM) enhances or replaces geriatric assessment (GA) in risk-stratifying pancreatic surgery patients. One hundred thirty-four pancreatic surgery patients were identified from a prospective cohort. Sixty-three patients in the cohort had preoperative CT scans in addition to comprehensive geriatric assessments. CT scans were processed using AM. Associations with National Surgical Quality Improvement Program (NSQIP) serious complications were evaluated using univariate analysis and robust elastic net modeling to obtain AUROC curves by adding AM and GA measures to our previously defined clinical base risk model (age, body mass index, American Society of Anesthesiologists classification, and Charlson comorbidity index). NSQIP serious complications were associated with low psoas Hounsfield units (HUs) (p = 0.002), low-density (0 to 30 HU) psoas area (p = 0.01), visceral fat HU (p ≤ 0.001), visceral fat area (p = 0.009), subcutaneous fat HU (p = 0.023), and total body area (p = 0.012) on univariate analysis. Elastic net models incorporating the base model with geriatric assessment and psoas HU (AUC = 0.751), and AM alone (AUC = 0.739) have greater predictive value than the base model alone (AUC = 0.601). The model utilizing AM and GA in combination had the highest predictive value (AUC = 0.841). When combined, AM and GA improve prediction of NSQIP serious complications compared to either technique alone. The additive nature of these two modalities suggests they likely capture unique aspects of a patient's fitness for surgery.
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167
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Back Muscle Morphometry: Effects on Outcomes of Spine Surgery. World Neurosurg 2017; 103:174-179. [PMID: 28366754 DOI: 10.1016/j.wneu.2017.03.097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND This review seeks to synthesize emerging literature on the effects of back muscle size on outcomes in spine surgery. Risk factors that contribute to poor surgical outcomes continue to be an area of interest in spine surgery because proper risk stratification can result in reduction in morbidity and enhanced patient care. However, the impact of muscle size on spine surgical outcomes is an understudied avenue with paucity of data evaluating the relationship among back muscles and surgical outcomes, patient's quality of life, and functional improvement postoperatively. METHODS This review was centered around identifying studies that assessed the impact of back muscle size on spine surgery outcomes. RESULTS Five retrospective studies were selected for review. All studies set out to see if differences in muscle size existed in patients with disparate post-operative outcomes as a primary objective. The studies support the association between larger back muscles and improved outcomes. The size and relative cross sectional area of paraspinal muscles and the size of the psoas muscle were associated with functional outcomes, incidence of complications and also fusion rates. CONCLUSION With reduction in surgical complications and improvement in postoperative functional outcomes, back muscle morphometry ought to be included in the preoperative surgical planning as a predictor of outcomes.
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168
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Palmela C, Velho S, Agostinho L, Branco F, Santos M, Santos MPC, Oliveira MH, Strecht J, Maio R, Cravo M, Baracos VE. Body Composition as a Prognostic Factor of Neoadjuvant Chemotherapy Toxicity and Outcome in Patients with Locally Advanced Gastric Cancer. J Gastric Cancer 2017; 17:74-87. [PMID: 28337365 PMCID: PMC5362836 DOI: 10.5230/jgc.2017.17.e8] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 12/29/2022] Open
Abstract
Purpose Neoadjuvant chemotherapy has been shown to improve survival in locally advanced gastric cancer, but it is associated with significant toxicity. Sarcopenia and sarcopenic obesity have been studied in several types of cancers and have been reported to be associated with higher chemotherapy toxicity and morbi-mortality. The aim of this study was to assess the prevalence of sarcopenia/sarcopenic obesity in patients with gastric cancer, as well as its association with chemotherapy toxicity and long-term outcomes. Materials and Methods A retrospective analysis was performed using an academic cancer center patient cohort diagnosed with locally advanced gastric cancer between January 2012 and December 2014 and treated with neoadjuvant chemotherapy. We analyzed body composition (skeletal muscle and visceral fat index) in axial computed tomography images. Results A total of 48 patients met the inclusion criteria. The mean age was 68±10 years, and 33 patients (69%) were men. Dose-limiting toxicity was observed in 22 patients (46%), and treatment was terminated early owing to toxicity in 17 patients (35%). Median follow-up was 17 months. Sarcopenia and sarcopenic obesity were found at diagnosis in 23% and 10% of patients, respectively. We observed an association between termination of chemotherapy and both sarcopenia (P=0.069) and sarcopenic obesity (P=0.004). On multivariate analysis, the odds of treatment termination were higher in patients with sarcopenia (odds ratio=4.23; P=0.050). Patients with sarcopenic obesity showed lower overall survival (median survival of 6 months [95% confidence interval {CI}=3.9–8.5] vs. 25 months [95% CI=20.2–38.2]; log-rank test P=0.000). Conclusions Sarcopenia and sarcopenic obesity were associated with early termination of neoadjuvant chemotherapy in patients with gastric cancer; additionally, sarcopenic obesity was associated with poor survival.
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Affiliation(s)
- Carolina Palmela
- Division of Gastroenterology, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Sónia Velho
- Nutrition Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Lisa Agostinho
- Radiology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Marta Santos
- General Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Maria Pia Costa Santos
- Division of Gastroenterology, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - João Strecht
- Radiology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Rui Maio
- General Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Marília Cravo
- Division of Gastroenterology, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Vickie E Baracos
- Division of Palliative Care Medicine, Department of Oncology, Cross Cancer Institute, University of Alberta, Alberta, Canada
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169
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Wada Y, Kamishima T, Shimamura T, Kawamura N, Yamashita K, Sutherland K, Takeda H. Pre-operative volume rather than area of skeletal muscle is a better predictor for post-operative risks for respiratory complications in living-donor liver transplantation. Br J Radiol 2017; 90:20160938. [PMID: 28181820 DOI: 10.1259/bjr.20160938] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To demonstrate the superiority of total psoas volume (TPV) over total psoas area (TPA) in terms of predicting post-operative complications in living-donor liver transplantation (LDLT). METHODS The TPA and TPV were assessed in 32 recipients who underwent CT before LDLT. The TPA was measured using an axial CT image at the level of the upper margin of the fourth lumbar vertebral body. The TPV was calculated using all the CT images from the muscle origin through the level of the pubic symphysis. Patients were divided into a sarcopenia group and no-sarcopenia group based on the medians of normalized TPA (nTPA) and normalized TPV (nTPV). We calculated the odds ratio (OR) of post-operative respiratory complications in relation to nTPA and nTPV, respectively. RESULTS Out of 32 recipients, 17 recipients experienced at least 1 post-operative respiratory complication. The OR for males according to nTPV [OR = 15.00, 95% confidence interval (CI) = 1.03-218.31; p = 0.031] was higher than that for nTPA (OR = 3.33, 95% CI = 0.36-30.70; p = 0.280). The OR for females according to nTPV (OR = 4.00, 95% CI = 0.56-28.40; p = 0.16) was the same as that for nTPA (OR = 4.00, 95% CI = 0.56-28.40; p = 0.16). CONCLUSION Pre-operative volume of the skeletal muscle might be a better predictor for post-operative risks in LDLT recipients than pre-operative area of the skeletal muscle. Advances in knowledge: Post-operative risks for respiratory complications in LDLT recipients might be evaluated more accurately by using TPV instead of TPA.
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Affiliation(s)
- Yuki Wada
- 1 Department of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tamotsu Kamishima
- 2 Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tsuyoshi Shimamura
- 3 Division of Organ Transplantation, Hokkaido University Hospital, Sapporo, Japan
| | - Norio Kawamura
- 4 Gastroenterological Surgery 1, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kenichiro Yamashita
- 5 Department of Transplant Surgery, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kenneth Sutherland
- 6 Department of Medical Physics, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroshi Takeda
- 7 Laboratory of Pathophysiology and Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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170
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Sarcopenia predicts costs among patients undergoing major abdominal operations. Surgery 2016; 160:1162-1171. [DOI: 10.1016/j.surg.2016.05.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/27/2016] [Accepted: 05/03/2016] [Indexed: 01/06/2023]
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171
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Sandini M, Bernasconi DP, Fior D, Molinelli M, Ippolito D, Nespoli L, Caccialanza R, Gianotti L. A high visceral adipose tissue-to-skeletal muscle ratio as a determinant of major complications after pancreatoduodenectomy for cancer. Nutrition 2016; 32:1231-7. [PMID: 27261062 DOI: 10.1016/j.nut.2016.04.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/08/2016] [Accepted: 04/11/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Complication rates after pancreatic resections remain high despite improvement in perioperative management. The effects of body composition and the relationship among different body compartments on surgical morbidity are not comprehensively investigated. The aim of this study was to assess whether the evaluation of different body compartments and their relationship was associated with the development of major postoperative complications after pancreatoduodenectomy (PD) for cancer. METHODS We retrospectively analyzed 124 patients who underwent PD and had a staging computed tomography (CT) scan at our center. CT scan was used to measure abdominal skeletal muscle area and volume, as well as visceral fat area (VFA) and volume. The total abdominal muscle area (TAMA) was then normalized for height. The severity of complications was assessed. Univariate and multivariate analyses were performed to investigate correlations between the above variables and postoperative complications. The receiver operating characteristic curve methodology was used to investigate the predictive ability of each parameter. RESULTS Major complications occurred in 42 patients (33.9%). The prevalence of sarcopenia was 24.2%. Regression analyses revealed no correlation between abdominal muscular and adipose tissue areas. Univariate analysis showed that the depletion of muscle area normalized for height was not per se predictive of complications (P = 0.318). Multivariate logistic regression showed that the VFA/TAMA was the only determinant of major complications (odds ratio, 3.20; 95% confidence interval, 1.35-7.60; P = 0.008). The model predictive performance was 0.735 (area under the curve) with a sensitivity of 64.3% and a specificity of 74.4%. CONCLUSION Sarcopenic obesity is a strong predictor of major complications after PD for cancer.
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Affiliation(s)
- Marta Sandini
- School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - Davide P Bernasconi
- School of Medicine and Surgery, Center of Biostatistics for Clinical Epidemiology, Milano-Bicocca University, Monza, Italy
| | - Davide Fior
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - Matilde Molinelli
- School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | | | - Luca Nespoli
- School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - Riccardo Caccialanza
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
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172
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Mei KL, Batsis JA, Mills JB, Holubar SD. Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery? Perioper Med (Lond) 2016; 5:30. [PMID: 27800156 PMCID: PMC5080704 DOI: 10.1186/s13741-016-0052-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/26/2016] [Indexed: 12/25/2022] Open
Abstract
Sarcopenia, or loss of skeletal muscle mass and quality, has been studied as part of aging and adverse health outcomes in elderly patients but has only recently been evaluated as a separate condition in cancer patients and important indicator of adverse outcomes. Currently, its definition and method of assessment are still being debated. Sarcopenia within an increasingly obese population has led to a subgroup with sarcopenic obesity, at even higher risk of adverse outcomes. Yet, sarcopenia often goes undiagnosed in these patients, hidden beneath higher body mass index. Identifying sarcopenic and sarcopenic obese subpopulations would allow for more effective treatment plans and potential avoidance of suboptimal outcomes, as well as the chance to intervene and combat these modifiable risk factors. This review will examine available literature on the definition and methods of evaluating sarcopenia and sarcopenic obesity, summarize the effectiveness of sarcopenia and sarcopenic obesity as predictors of outcomes after gastrointestinal cancer surgery, including colorectal cancer resection, liver resection, and pancreatic resection, and outline strategies to minimize the impact of sarcopenia. It is clear that untreated sarcopenia and sarcopenic obesity can be associated with suboptimal post-operative outcomes, especially infections and disease-free or overall survival.
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Affiliation(s)
| | - John A. Batsis
- Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
- Geisel School of Medicine at Dartmouth, Hanover, NH USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH USA
| | | | - Stefan D. Holubar
- Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
- Geisel School of Medicine at Dartmouth, Hanover, NH USA
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173
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Van Rijssen LB, van Huijgevoort NCM, Coelen RJS, Tol JA, Haverkort EB, Nio CY, Busch OR, Besselink MG. Skeletal Muscle Quality is Associated with Worse Survival After Pancreatoduodenectomy for Periampullary, Nonpancreatic Cancer. Ann Surg Oncol 2016; 24:272-280. [PMID: 27638672 PMCID: PMC5179584 DOI: 10.1245/s10434-016-5495-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Body composition measures may predict outcomes of cancer surgery. Whereas low muscle mass shown on preoperative computed tomography (CT) scans has been associated with worse outcomes after surgery for pancreatic cancer, less consideration has been given to low muscle attenuation, reflecting poor muscle quality. Studies relating muscle mass and muscle attenuation with outcomes for patients with periampullary, nonpancreatic cancer are lacking. METHODS Skeletal muscle mass and attenuation were assessed in 166 consecutive patients undergoing pancreatoduodenectomy (PD) for periampullary, nonpancreatic cancer at a single center between 2000 and 2012. The skeletal muscle index (SMI) was calculated from cross-sectional muscle area on preoperative CT imaging at the third lumbar vertebra level (L3) and normalized for height. The skeletal muscle attenuation index (MAI) was calculated by measuring the average Hounsfield units of the total muscle area at the L3 level. Overall survival (OS) and the rate of major postoperative complications (Clavien-Dindo ≥3) were extracted from prospectively maintained databases. RESULTS Low SMI was present in 78.3 % and low MAI in 48.8 % of the patients. The multivariate analysis showed lymph node metastasis [hazard ratio (HR) 1.8; 95 % confidence interval (CI) 1.1-2.9], microscopic radicality (HR 2.0; 95 % CI 1.2-3.4), and low MAI (HR 2.0; 95 % CI 1.2-3.3), but not low SMI to be significantly associated with decreased OS. Low MAI (HR 1.9; 95 % CI 1.0-3.8) was the only independent risk factor for major postoperative complications. CONCLUSION Skeletal muscle quality, but not muscle mass, predicted survival and major complications after PD for periampullary, nonpancreatic cancer. Preoperative CT-derived body composition measures may stratify patients into risk categories and support shared decision making.
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Affiliation(s)
- L B Van Rijssen
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - R J S Coelen
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - J A Tol
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - E B Haverkort
- Department of Nutrition and Dietetics, Academic Medical Center, Amsterdam, The Netherlands
| | - C Y Nio
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - O R Busch
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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174
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Nishida Y, Kato Y, Kudo M, Aizawa H, Okubo S, Takahashi D, Nakayama Y, Kitaguchi K, Gotohda N, Takahashi S, Konishi M. Preoperative Sarcopenia Strongly Influences the Risk of Postoperative Pancreatic Fistula Formation After Pancreaticoduodenectomy. J Gastrointest Surg 2016; 20:1586-94. [PMID: 27126054 DOI: 10.1007/s11605-016-3146-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/30/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy (PD). Sarcopenia is a newly identified marker of frailty. We performed this study to assess whether preoperative sarcopenia has an impact on clinically relevant POPF formation. METHODS A total of 266 consecutive patients who underwent a PD between 2010 and 2014 were enrolled in this retrospective study. Skeletal muscle mass was measured using preoperative computed tomography images. The impact of preoperative sarcopenia on clinically relevant POPF formation was analyzed using univariate and multivariate analyses. RESULTS Of the 266 patients, 132 (49.6 %) were classified as having preoperative sarcopenia. The rate of clinically relevant POPF formation was significantly higher in the sarcopenia group (22.0 vs. 10.4 %; P = 0.011). A multivariate logistic regression analysis showed that sarcopenia (odds ratio, 2.869; P = 0.007) was an independent risk factor for the development of clinically relevant POPF, along with a soft pancreas and a parenchymal thickness at the pancreatic resection site of ≥8 mm. CONCLUSIONS Preoperative sarcopenia was identified as a strong and independent risk factor for clinically relevant POPF formation after PD. Perioperative rehabilitation and nutrition therapy may contribute to the prevention of POPF formation and a safer PD.
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Affiliation(s)
- Yasunori Nishida
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuichiro Kato
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Masashi Kudo
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hidetoshi Aizawa
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Satoshi Okubo
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Daigoro Takahashi
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yusuke Nakayama
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Kazuhiko Kitaguchi
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Shinichiro Takahashi
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaru Konishi
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
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175
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Rier HN, Jager A, Sleijfer S, Maier AB, Levin MD. The Prevalence and Prognostic Value of Low Muscle Mass in Cancer Patients: A Review of the Literature. Oncologist 2016; 21:1396-1409. [PMID: 27412391 DOI: 10.1634/theoncologist.2016-0066] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/17/2016] [Indexed: 12/11/2022] Open
Abstract
: In several diseases, low muscle mass has been revealed as an unfavorable prognostic factor for outcome. Whether this holds true in patients with solid malignancies as well has increasingly been explored recently. However, this research field is severely hampered by a lack of consensus on how to determine muscle mass in cancer patients and on the definition of low muscle mass. Consequently, the prevalence of low muscle mass varies widely across several studies. Nevertheless, most studies show that, in patients with solid malignancies, low muscle mass is associated with a poor outcome. In the future, more research is needed to get better insight into the best method to determine muscle mass, the exact prognostic value of low muscle mass in diverse tumor types and stages, pathophysiology of low muscle mass in patients with cancer, and ways to intervene and improve muscle mass in patients. This review addresses the current literature on the importance of muscle mass in cancer patients and the methods of muscle measurement. IMPLICATIONS FOR PRACTICE An increasing number of studies underline the clinical value of low muscle mass as a prognostic factor for adverse outcomes in cancer patients. However, studies show large heterogeneity because of the lack of a standardized approach to measure muscle mass and the lack of reference populations. As a result, the interpretation of data and further progress are severely hampered, hindering the implementation of muscle measurement in oncological care. This review summarizes the methods of diagnosing low muscle mass in cancer patients, the difference between underlying syndromes such as sarcopenia and cachexia, and the association with clinical outcomes described so far.
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Affiliation(s)
- Hánah N Rier
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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176
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Sato T, Aoyama T, Hayashi T, Segami K, Kawabe T, Fujikawa H, Yamada T, Yamamoto N, Oshima T, Rino Y, Masuda M, Ogata T, Cho H, Yoshikawa T. Impact of preoperative hand grip strength on morbidity following gastric cancer surgery. Gastric Cancer 2016; 19:1008-15. [PMID: 26466832 DOI: 10.1007/s10120-015-0554-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sarcopenia is a decrease in both muscle mass and strength. It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery. This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery. METHODS A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined. Patients with performance status 3 or 4 were excluded. Preoperative lean body mass (LBM) was evaluated by bioelectrical impedance analysis and expressed as LBM index. Preoperative muscle function was measured by hand grip strength (HGS). The cutoff values were the gender-specific lowest 20 %. Grade 2 or higher morbidities, as retrospectively evaluated by the Clavien-Dindo classification, were obtained from the patient record. The risk factors for morbidity were examined by univariate and multivariate analyses. RESULTS Morbidity was observed in 39 patients (13.3 %), including 7 with pancreatic leakage, 12 with anastomotic leakage, and 4 with intraabdominal abscesses, but no mortality was observed. The univariate analysis showed that male gender, total gastrectomy, splenectomy, and a low HGS were significant risk factors for morbidity. A low LBM was not a significant risk factor. A low HGS, male gender, and total gastrectomy remained significant in the multivariate analysis. CONCLUSIONS A low hand grip strength was a significant risk factor for morbidity after gastric cancer surgery. The importance of the hand grip strength as a risk factor should be examined in future prospective studies.
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Affiliation(s)
- Tsutomu Sato
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.,Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.,Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Tsutomu Hayashi
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Kenki Segami
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.,Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Taiichi Kawabe
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.,Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Hirohito Fujikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.,Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Takanobu Yamada
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Naoto Yamamoto
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Takashi Oshima
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan
| | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan. .,Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
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177
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Joglekar S, Nau PN, Mezhir JJ. The impact of sarcopenia on survival and complications in surgical oncology: A review of the current literature--Author response. J Surg Oncol 2016; 112:910. [PMID: 26768515 DOI: 10.1002/jso.24095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Savita Joglekar
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Peter N Nau
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - James J Mezhir
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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178
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Hendifar A, Osipov A, Khanuja J, Nissen N, Naziri J, Yang W, Li Q, Tuli R. Influence of Body Mass Index and Albumin on Perioperative Morbidity and Clinical Outcomes in Resected Pancreatic Adenocarcinoma. PLoS One 2016; 11:e0152172. [PMID: 27015568 PMCID: PMC4807776 DOI: 10.1371/journal.pone.0152172] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/09/2016] [Indexed: 01/06/2023] Open
Abstract
Obesity is a known risk factor for PDA and recent reports suggest obesity has a negative impact on clinical outcomes in patients with PDA. Pretreatment body mass index (BMI) and serum albumin (SA) have been shown to be associated with worse overall survival in patients with advanced and metastatic PDA. However, minimal data exists on the impact of BMI and SA on perioperative and long-term clinical outcomes in patients with early-stage resected PDA. Herein, we report on the impact of these variables on perioperative clinical outcomes, overall survival (OS) and disease free survival (DFS) in patients with resected PDA. With IRB approval, we evaluated 1,545 patients with PDA treated at a single institution from 2007–2013 and identified 106 patients who underwent upfront resection with curative intent. BMI and SA were calculated preoperatively and at the time of last clinical evaluation. Influence of preoperative BMI, SA, change in either variable, and influence of other clinical and pathologic variables on perioperative morbidity and mortality was assessed. The impact of these variables on DFS and OS was assessed with cox regression modeling and ANOVA. Actuarial estimates for DFS and OS were calculated using Kaplan-Meier methods. Median follow up time was 16 months (3–89). Mean age was 68 years. Median survival was 14 months (3–65) and median time to recurrence was 11 months (1–79). Length of hospital stay was associated with BMI (p = .023), change in BMI (p = .003) and SA (p = .004). Post-operative transfusion rate was associated with SA (p = .021). There was a strong correlation between BMI change and positive margin (p = .04) and lymph node status (p = .01). On multivariate analysis, change in SA (p = .03) and node positivity (p = .008) were associated with decreased DFS. Additionally, preoperative SA (p = .023), node positivity (p = .026) and poor differentiation (p = .045) were associated with worse OS on multivariate analysis. Low preoperative SA was associated with worse DFS and OS in patients with resected PDA. Lower BMI and SA were associated with longer post-operative hospital stay. Our study is one of the first to describe how pre-operative BMI and SA and post-operative changes in these variables impact clinical and perioperative outcomes. This data supports nutritional status and weight loss as predictors of outcome in resected pancreatic cancer patients and warrants further prospective investigation.
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Affiliation(s)
- Andrew Hendifar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Arsen Osipov
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Jasleen Khanuja
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Nicholas Nissen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Jason Naziri
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Wensha Yang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Quanlin Li
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Richard Tuli
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- * E-mail:
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179
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Wagner D, DeMarco MM, Amini N, Buttner S, Segev D, Gani F, Pawlik TM. Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery. World J Gastrointest Surg 2016; 8:27-40. [PMID: 26843911 PMCID: PMC4724585 DOI: 10.4240/wjgs.v8.i1.27] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/19/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023] Open
Abstract
According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation - equating to about 36 million older surgical patients. Older adults are prone to complications during gastrointestinal cancer treatment and therefore may need to undergo special pretreatment assessments that incorporate frailty and sarcopenia assessments. A focused, structured literature review on PubMed and Google Scholar was performed to identify primary research articles, review articles, as well as practice guidelines on frailty and sarcopenia among patients undergoing gastrointestinal surgery. The initial search identified 450 articles; after eliminating duplicates, reports that did not include surgical patients, case series, as well as case reports, 42 publications on the impact of frailty and/or sarcopenia on outcome of patients undergoing gastrointestinal surgery were included. Frailty is defined as a clinically recognizable state of increased vulnerability to physiologic stressors resulting from aging. Frailty is associated with a decline in physiologic reserve and function across multiple physiologic systems. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Unlike cachexia, which is typically associated with weight loss due to chemotherapy or a general malignancy-related cachexia syndrome, sarcopenia relates to muscle mass rather than simply weight. As such, while weight reflects nutritional status, sarcopenia - the loss of muscle mass - is a more accurate and quantitative global marker of frailty. While chronologic age is an important element in assessing a patient's peri-operative risk, physiologic age is a more important determinant of outcomes. Geriatric assessment tools are important components of the pre-operative work-up and can help identify patients who suffer from frailty. Such data are important, as frailty and sarcopenia have repeatedly been demonstrated among the strongest predictors of both short- and long-term outcome following complicated surgical procedures such as esophageal, gastric, colorectal, and hepato-pancreatico-biliary resections.
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180
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Buettner S, Wagner D, Kim Y, Margonis GA, Makary MA, Wilson A, Sasaki K, Amini N, Gani F, Pawlik TM. Inclusion of Sarcopenia Outperforms the Modified Frailty Index in Predicting 1-Year Mortality among 1,326 Patients Undergoing Gastrointestinal Surgery for a Malignant Indication. J Am Coll Surg 2015; 222:397-407.e2. [PMID: 26803743 DOI: 10.1016/j.jamcollsurg.2015.12.020] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/10/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although it is a useful metric for preoperative risk stratification, frailty can be difficult to identify in patients before surgery. We sought to develop a preoperative frailty-risk model combining sarcopenia with clinical parameters to predict 1-year mortality using a cohort of patients undergoing gastrointestinal cancer surgery. STUDY DESIGN We identified 1,326 patients undergoing hepatobiliary, pancreatic, or colorectal surgery between 2011 and 2014. Sarcopenia defined by psoas density was measured using preoperative cross-sectional imaging. Multivariable Cox regression analysis was performed to identify preoperative risk factors associated with 1-year mortality and used to develop a preoperative risk-stratification score. RESULTS Among all patients identified, 640 (48.3%) patients underwent pancreatic surgery, 347 (26.2%) underwent a hepatobiliary procedure, and 339 (25.5%) a colorectal procedure. Using sex-specific cut-offs, 398 (30.0%) patients were categorized as sarcopenic. Sarcopenic patients were more likely to develop postoperative complications vs non-sarcopenic patients (odds ratio [OR] 1.80, 95% CI 1.42 to 2.29; p < 0.001). Overall 1-year mortality was 9.4%. On multivariable analysis, independent risk factors for 1-year mortality included increasing age (65 to 75 years: [hazard ratio (HR) 1.81, 95% CI 1.05 to 3.14] greater than 75 years [HR 2.79, 95% CI 1.55 to 5.02]), preoperative anemia hemoglobin < 12.5 g/dL (HR 1.68, 95% CI 1.17 to 2.40), and preoperative sarcopenia (HR 1.98, 95% CI 1.36 to 2.88; all p < 0.05). Using these variables, a 28-point weighed composite score was able to stratify patients by their risk for mortality 1 year after surgery (C-statistic = 0.70). The proposed score outperformed other indices of frailty including the modified Frailty Index (C-statistic = 0.55) and the Eastern Cooperative Oncology Group (ECOG) performance score (C-statistic = 0.57) (both p < 0.05). CONCLUSION Sarcopenia was combined with clinical factors to generate a composite risk-score that can be used to identify frail patients at greatest risk for 1-year mortality after gastrointestinal cancer surgery.
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Affiliation(s)
- Stefan Buettner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Doris Wagner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Yuhree Kim
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | | | - Martin A Makary
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Ana Wilson
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Kazunari Sasaki
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Neda Amini
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Faiz Gani
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
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181
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Kobayashi A, Kaido T, Hamaguchi Y, Okumura S, Taura K, Hatano E, Okajima H, Uemoto S. Impact of postoperative changes in sarcopenic factors on outcomes after hepatectomy for hepatocellular carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 23:57-64. [PMID: 26572789 DOI: 10.1002/jhbp.302] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/08/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND We have reported that preoperative low skeletal muscle quality was an independent risk factor for poor outcomes after hepatectomy for hepatocellular carcinoma (HCC). However, postoperative changes of quality as well as quantity of skeletal muscle after hepatectomy for HCC and their impact on postoperative outcomes have not been fully investigated. METHODS We retrospectively analyzed 241 patients undergoing primary hepatectomy for HCC between January 2007 and September 2012. The quality and quantity of skeletal muscle were evaluated by intramuscular adipose tissue content (IMAC) and the psoas muscle mass index (PMI) using computed tomography imaging at the umbilical level, respectively. We evaluated postoperative changes in IMAC and PMI in patients according to preoperative sarcopenia, sex, and surgical procedure. We also investigated the impact of ΔIMAC and ΔPMI on HCC recurrence in patients with preoperative normal IMAC. RESULTS On multivariate analysis, indocyanine green retention test at 15 min ≥ 15% (odds ratio [OR] = 3.156; P = 0.041) and high ΔIMAC at 6 months after hepatectomy (OR = 3.713; P = 0.024) were the risk factors for HCC recurrence in patients with preoperative normal IMAC. CONCLUSION Postoperative depletion of skeletal muscle quality is closely involved with HCC recurrence after hepatectomy for HCC.
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Affiliation(s)
- Atsushi Kobayashi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku,, Kyoto, 606-8507, Japan
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku,, Kyoto, 606-8507, Japan.
| | - Yuhei Hamaguchi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku,, Kyoto, 606-8507, Japan
| | - Shinya Okumura
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku,, Kyoto, 606-8507, Japan
| | - Kojiro Taura
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku,, Kyoto, 606-8507, Japan
| | - Etsuro Hatano
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku,, Kyoto, 606-8507, Japan
| | - Hideaki Okajima
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku,, Kyoto, 606-8507, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku,, Kyoto, 606-8507, Japan
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182
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Wagner D, Büttner S, Kim Y, Gani F, Xu L, Margonis GA, Amini N, Kamel IR, Pawlik TM. Clinical and morphometric parameters of frailty for prediction of mortality following hepatopancreaticobiliary surgery in the elderly. Br J Surg 2015; 103:e83-92. [PMID: 26604018 DOI: 10.1002/bjs.10037] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/05/2015] [Accepted: 09/22/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although frailty is a known determinant of poor postoperative outcomes, it can be difficult to identify in patients before surgery. The authors sought to develop a preoperative frailty risk model to predict mortality among patients aged 65 years or more. METHODS Clinical and morphometric data including total psoas area (TPA), total psoas volume (TPV) and psoas density (Hounsfield unit average calculation, HUAC) were collected for patients undergoing hepatopancreaticobiliary (HPB) surgery between 2012 and 2014. Multivariable Cox proportional hazards regression was used to identify preoperative risk factors associated with 1-year mortality. RESULTS The median age of the 518 patients included in the study was 72 (i.q.r. 68-76) years; 55·6 per cent of patients were men, and half of the cohort had multiple co-morbidities (Charlson co-morbidity index (CCI) of 4 or more, 55·6 per cent). TPA cut-offs to define sarcopenia were 552·7 mm(2) /m(2) in women and 702·9 mm(2) /m(2) in men; cut-offs for TPV were 18·2 cm(3) /m(2) in women and 26·2 cm(3) /m(2) in men, whereas HUAC cut-offs were 31·1 HU in women and 33·3 HU in men. The overall 1-year mortality rate was 14·1 per cent. In multivariable analysis, risk factors associated with 1-year mortality included CCI of 4 or above (hazard ratio (HR) 2·91, 95 per cent c.i. 1·47 to 5·77; P = 0·002), malignant disease (HR 3·94, 1·17 to 13·30; P = 0·027) and sarcopenia by HUAC (HR 1·85, 1·10 to 3·10; P = 0·021). A weighted 25-point composite score was developed to stratify patients at risk of 1-year postoperative mortality. The 1-year mortality rate was noted to be 2·5 per cent among patients scoring 0-10 (low risk), 17·3 per cent among patients scoring 11-20 (intermediate risk) and 29·2 per cent among those scoring between 21 and 25 (high risk) (P < 0·001). CONCLUSION Clinical and morphometric measures of frailty accurately predict the risk of 1-year mortality following HPB surgery in elderly patients, and can be used to risk-stratify patients appropriately.
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Affiliation(s)
- D Wagner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Büttner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Y Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - F Gani
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - L Xu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - G A Margonis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Amini
- Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - I R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - T M Pawlik
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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183
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van Vugt JL, Levolger S, Coelen RJ, de Bruin RW, IJzermans JN. The impact of sarcopenia on survival and complications in surgical oncology: A review of the current literature. J Surg Oncol 2015; 112:681-2. [DOI: 10.1002/jso.24064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/27/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Jeroen L.A. van Vugt
- Department of Surgery; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Stef Levolger
- Department of Surgery; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Robert J.S. Coelen
- Department of Surgery; Academic Medical Center; Amsterdam The Netherlands
| | - Ron W.F. de Bruin
- Department of Surgery; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Jan N.M. IJzermans
- Department of Surgery; Erasmus University Medical Center; Rotterdam The Netherlands
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