1
|
Zhang QH, Ma JD, Lu YM, Zhang RN, Zhao ZH, Li YT, Chen QP. Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis. World J Gastrointest Surg 2024; 16:1857-1870. [PMID: 38983342 PMCID: PMC11230021 DOI: 10.4240/wjgs.v16.i6.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength, as well as a decline in functional ability, which is associated with malnutrition, hormonal changes, chronic inflammation, disturbance of intestinal flora, and exercise quality. Pancreatoduodenectomy is a commonly employed clinical intervention for conditions such as pancreatic head cancer, ampulla of Vater cancer, and cholangiocarcinoma, among others, with a notably high rate of postoperative complications. Sarcopenia is frequent in patients undergoing pancreatoduodenectomy. However, data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy (PD) are both limited and inconsistent. AIM To assess the influence of sarcopenia on outcomes in patients undergoing PD. METHODS The PubMed, Cochrane Library, Web of Science, and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD. Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria. Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted. Forest and funnel plots were used, respectively, to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias. RESULTS Sixteen studies encompassing 2381 patients were included in the meta-analysis. The patients in the sarcopenia group (n = 833) had higher overall postoperative complication rates [odds ratio (OR) = 3.42, 95% confidence interval (CI): 1.95-5.99, P < 0.0001], higher Clavien-Dindo class ≥ III major complication rates (OR = 1.41, 95%CI: 1.04-1.90, P = 0.03), higher bacteremia rates (OR = 4.46, 95%CI: 1.42-13.98, P = 0.01), higher pneumonia rates (OR = 2.10, 95%CI: 1.34-3.27, P = 0.001), higher pancreatic fistula rates (OR = 1.42, 95%CI: 1.12-1.79, P = 0.003), longer hospital stays (OR = 2.86, 95%CI: 0.44-5.28, P = 0.02), higher mortality rates (OR = 3.17, 95%CI: 1.55-6.50, P = 0.002), and worse overall survival (hazard ratio = 2.81, 95%CI: 1.45-5.45, P = 0.002) than those in the non-sarcopenia group (n = 1548). However, no significant inter-group differences were observed regarding wound infections, urinary tract infections, biliary fistulas, or postoperative digestive bleeding. CONCLUSION Sarcopenia is a common comorbidity in patients undergoing PD. Patients with preoperative sarcopenia have increased rates of complications and mortality, in addition to a poorer overall survival rate and longer hospital stays after PD.
Collapse
Affiliation(s)
- Qi-Hui Zhang
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Jin-Dong Ma
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Yan-Min Lu
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Run-Nan Zhang
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Zhong-Hua Zhao
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Ya-Tong Li
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Qiang-Pu Chen
- Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| |
Collapse
|
2
|
Guarneri G, Pecorelli N, Bettinelli A, Campisi A, Palumbo D, Genova L, Gasparini G, Provinciali L, Della Corte A, Abati M, Aleotti F, Crippa S, De Cobelli F, Falconi M. Prognostic value of preoperative CT scan derived body composition measures in resected pancreatic cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106848. [PMID: 36863915 DOI: 10.1016/j.ejso.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND It remains unclear whether preoperative body composition may affect the prognosis of pancreatic cancer patients undergoing surgery. The aim of the present study was to assess the extent to which preoperative body composition impacts on postoperative complication severity and survival in patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC). METHODS A retrospective cohort study was performed on consecutive patients who underwent pancreatoduodenectomy with preoperative CT scan imaging available. Body composition parameters including total abdominal muscle area (TAMA), visceral fat area (VFA), subcutaneous fat area and liver steatosis (LS) were assessed. Sarcopenic obesity was defined as a high VFA/TAMA ratio. Postoperative complication burden was evaluated with the comprehensive complication index (CCI). RESULTS Overall, 371 patients were included in the study. At 90 days after surgery, 80 patients (22%) experienced severe complications. The median CCI was 20.9 (IQR 0-30). At multivariate linear regression analysis, preoperative biliary drainage, ASA score ≥3, fistula risk score and sarcopenic obesity (37% increase; 95%CI 0.06-0.74; p = 0.046) were associated to an increase in CCI. Patient characteristics associated to sarcopenic obesity were older age, male gender and preoperative LS. At a median follow-up of 25 months (IQR 18-49), median disease-free survival (DFS) was 19 months (IQR 15-22). At cox-regression analysis, only pathological features were associated with DFS, while LS and other body composition measures did not show any prognostic role. CONCLUSION The combination of sarcopenia and visceral obesity was significantly associated with increased complication severity after pancreatoduodenectomy for cancer. Patients' body composition did not affect disease free survival after pancreatic cancer surgery.
Collapse
Affiliation(s)
- Giovanni Guarneri
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Pecorelli
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | | | | | - Diego Palumbo
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Luana Genova
- Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Angelo Della Corte
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Martina Abati
- Nutrition Service, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Aleotti
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Crippa
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
3
|
Clement D, Brown S, Leerdam MV, Tesselaar M, Ramage J, Srirajaskanthan R. Sarcopenia and Neuroendocrine Neoplasms. Curr Oncol Rep 2024; 26:121-128. [PMID: 38270848 DOI: 10.1007/s11912-024-01494-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE OF THE REVIEW To summarise the current literature regarding the presence of sarcopenia in patients with neuroendocrine neoplasms (NENs). These are uncommon cancers separated into well-differentiated neuroendocrine tumours (NETs) and poorly differentiated neuroendocrine carcinoma (NECs). For the diagnosis of sarcopenia, there needs to be low muscle strength and low muscle quantity/quality. RECENT FINDINGS Five studies exist describing either low muscle strength or low muscle quantity in patients with NETs. The studies used different techniques to analyse muscle strength and muscle quantity, included heterogeneous populations, and performed the analysis at different time points following the diagnosis of the NET. Only 2 studies regarding patients with NECs could be found, both included mainly patients with a mixed adenoneuroendocrine carcinoma (MiNEN) and are, therefore, difficult to interpret for patients with a NEC. The main findings of this review are to describe the presence of sarcopenia in patients with NENs. However, results should be interpreted with caution, and future research should focus on the correct technique, homogenous population and same time point.
Collapse
Affiliation(s)
- Dominique Clement
- Institute of Liver Studies, King's College Hospital ENETS Centre of Excellence, London, UK.
- Department of Gastroenterology, King's College Hospital, London, UK.
| | - Sarah Brown
- Institute of Liver Studies, King's College Hospital ENETS Centre of Excellence, London, UK
| | - Monique V Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Margot Tesselaar
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - John Ramage
- Institute of Liver Studies, King's College Hospital ENETS Centre of Excellence, London, UK
| | - Rajaventhan Srirajaskanthan
- Institute of Liver Studies, King's College Hospital ENETS Centre of Excellence, London, UK
- Department of Gastroenterology, King's College Hospital, London, UK
| |
Collapse
|
4
|
Khristenko E, Sinitsyn V, Rieden T, Girod P, Kauczor HU, Mayer P, Klauss M, Lyadov V. CT-based screening of sarcopenia and its role in cachexia syndrome in pancreatic cancer. PLoS One 2024; 19:e0291185. [PMID: 38271373 PMCID: PMC10810529 DOI: 10.1371/journal.pone.0291185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 08/23/2023] [Indexed: 01/27/2024] Open
Abstract
Since computed tomography (CT) is a part of standard diagnostic protocol in pancreatic ductal adenocarcinoma (PDAC), we have evaluated the value of CT for sarcopenia screening in patients with PDAC, intending to expand the diagnostic value of tomographic studies. In our study, we included 177 patients with available CT images. Two groups were formed: Group 1 consisted of 117 patients with PDAC in various locations and stages and Group 2, or the control group, consisted of 60 "nominally healthy" patients with other somatic non-oncological diseases. The body mass index (BMI) was defined as a ratio of patient's weight to the square of their height (kg/m2). CT-based body composition analysis was performed using commercially available software with evaluation of sarcopenia using skeletal muscle index (SMI, cm2/m2). Based on the SMI values, sarcopenia was found in 67.5% of patients (79 out of 117) in the first patient group. It was found more frequently in males (42 out of 56; 75%) than in females (37 out of 61; 60.6%). Additionally, we observed a decrease in muscle mass (hidden sarcopenia) in 79.7% in patients with a normal BMI. Even in overweight patients, sarcopenia was found in 50% (sarcopenic obesity). In patients with reduced BMI sarcopenia was found in all cases (100%). Statistically significant difference of SMI between two groups was revealed for both sexes (p = 0,0001), with no significant difference between groups in BMI. BMI is an inaccurate value for the assessment of body composition as it does not reflect in the details the human body structure. As SMI may correlate with the prognosis, decreased muscle mass- especially "hidden" sarcopenia or sarcopenic obesity- should be reported. The use of CT-based evaluation of sarcopenia and sarcopenic obesity will allow for a better treatment response assessment in patients with cancer cachexia.
Collapse
Affiliation(s)
- Ekaterina Khristenko
- Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Valentin Sinitsyn
- Department of Radiology at Medical Educational and Scientific Center University Hospital, Lomonosov Moscow State University, Moscow, Russia
| | - Tatiana Rieden
- Institute for Diagnostical and Interventional Radiology, Ludwigshafen Clinical Hospital, Ludwigshafen am Rhein, Germany
| | - Parker Girod
- University College Dublin School of Chemistry, Dublin, Ireland
| | - Hans-Ulrich Kauczor
- Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Mayer
- Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Miriam Klauss
- Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Vladimir Lyadov
- Moscow City Clinical Cancer Hospital No. 1, Oncology No. 4, Moscow, Russia
| |
Collapse
|
5
|
van der Kroft G, Wee L, Rensen SS, Brecheisen R, van Dijk DPJ, Eickhoff R, Roeth AA, Ulmer FT, Dekker A, Neumann UP, Olde Damink SWM. Identifying radiomics signatures in body composition imaging for the prediction of outcome following pancreatic cancer resection. Front Oncol 2023; 13:1062937. [PMID: 37637046 PMCID: PMC10449585 DOI: 10.3389/fonc.2023.1062937] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background Computerized radiological image analysis (radiomics) enables the investigation of image-derived phenotypes by extracting large numbers of quantitative features. We hypothesized that radiomics features may contain prognostic information that enhances conventional body composition analysis. We aimed to investigate whether body composition-associated radiomics features hold additional value over conventional body composition analysis and clinical patient characteristics used to predict survival of pancreatic ductal adenocarcinoma (PDAC) patients. Methods Computed tomography images of 304 patients undergoing elective pancreatic cancer resection were analysed. 2D radiomics features were extracted from skeletal muscle and subcutaneous and visceral adipose tissue (SAT and VAT) compartments from a single slice at the third lumbar vertebra. The study population was randomly split (80:20) into training and holdout subsets. Feature ranking with Least Absolute Shrinkage Selection Operator (LASSO) followed by multivariable stepwise Cox regression in 1000 bootstrapped re-samples of the training data was performed and tested on the holdout data. The fitted regression predictors were used as "scores" for a clinical (C-Score), body composition (B-Score), and radiomics (R-Score) model. To stratify patients into the highest 25% and lowest 25% risk of mortality compared to the middle 50%, the Harrell Concordance Index was used. Results Based on LASSO and stepwise cox regression for overall survival, ASA ≥3 and age were the most important clinical variables and constituted the C-score, and VAT-index (VATI) was the most important body composition variable and constituted the B-score. Three radiomics features (SATI_original_shape2D_Perimeter, VATI_original_glszm_SmallAreaEmphasis, and VATI_original_firstorder_Maximum) emerged as the most frequent set of features and yielded an R-Score. Of the mean concordance indices of C-, B-, and R-scores, R-score performed best (0.61, 95% CI 0.56-0.65, p<0.001), followed by the C-score (0.59, 95% CI 0.55-0.63, p<0.001) and B-score (0.55, 95% CI 0.50-0.60, p=0.03). Kaplan-Meier projection revealed that C-, B, and R-scores showed a clear split in the survival curves in the training set, although none remained significant in the holdout set. Conclusion It is feasible to implement a data-driven radiomics approach to body composition imaging. Radiomics features provided improved predictive performance compared to conventional body composition variables for the prediction of overall survival of PDAC patients undergoing primary resection.
Collapse
Affiliation(s)
- Gregory van der Kroft
- Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, European Surgical Center Aachen Maastricht (ESCAM), Aachen, Germany
| | - Leonard Wee
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sander S. Rensen
- Department of Surgery, Maastricht University Medical Center, European Surgical Center Aachen Maastricht (ESCAM), Maastricht, Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Ralph Brecheisen
- Department of Surgery, Maastricht University Medical Center, European Surgical Center Aachen Maastricht (ESCAM), Maastricht, Netherlands
| | - David P. J. van Dijk
- Department of Surgery, Maastricht University Medical Center, European Surgical Center Aachen Maastricht (ESCAM), Maastricht, Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Roman Eickhoff
- Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, European Surgical Center Aachen Maastricht (ESCAM), Aachen, Germany
| | - Anjali A. Roeth
- Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, European Surgical Center Aachen Maastricht (ESCAM), Aachen, Germany
| | - Florian T. Ulmer
- Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, European Surgical Center Aachen Maastricht (ESCAM), Aachen, Germany
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Ulf P. Neumann
- Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, European Surgical Center Aachen Maastricht (ESCAM), Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, European Surgical Center Aachen Maastricht (ESCAM), Maastricht, Netherlands
| | - Steven W. M. Olde Damink
- Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, European Surgical Center Aachen Maastricht (ESCAM), Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, European Surgical Center Aachen Maastricht (ESCAM), Maastricht, Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
6
|
Park LK, Lim KH, Volkman J, Abdiannia M, Johnston H, Nigogosyan Z, Siegel MJ, McGill JB, McKee AM, Salam M, Zhang RM, Ma D, Popuri K, Chow VTY, Beg MF, Hawkins WG, Peterson LR, Ippolito JE. Safety, tolerability, and effectiveness of the sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin in combination with standard chemotherapy for patients with advanced, inoperable pancreatic adenocarcinoma: a phase 1b observational study. Cancer Metab 2023; 11:6. [PMID: 37202813 DOI: 10.1186/s40170-023-00306-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy. Thus, there is an urgent need for safe and effective novel therapies. PDAC's excessive reliance on glucose metabolism for its metabolic needs provides a target for metabolic therapy. Preclinical PDAC models have demonstrated that targeting the sodium-glucose co-transporter-2 (SGLT2) with dapagliflozin may be a novel strategy. Whether dapagliflozin is safe and efficacious in humans with PDAC is unclear. METHODS We performed a phase 1b observational study (ClinicalTrials.gov ID NCT04542291; registered 09/09/2020) to test the safety and tolerability of dapagliflozin (5 mg p.o./day × 2 weeks escalated to 10 mg p.o./day × 6 weeks) added to standard Gemcitabine and nab-Paclitaxel (GnP) chemotherapy in patients with locally advanced and/or metastatic PDAC. Markers of efficacy including Response Evaluation Criteria in Solid Tumors (RECIST 1.1) response, CT-based volumetric body composition measurements, and plasma chemistries for measuring metabolism and tumor burden were also analyzed. RESULTS Of 23 patients who were screened, 15 enrolled. One expired (due to complications from underlying disease), 2 dropped out (did not tolerate GnP chemotherapy) during the first 4 weeks, and 12 completed. There were no unexpected or serious adverse events with dapagliflozin. One patient was told to discontinue dapagliflozin after 6 weeks due to elevated ketones, although there were no clinical signs of ketoacidosis. Dapagliflozin compliance was 99.4%. Plasma glucagon increased significantly. Although abdominal muscle and fat volumes decreased; increased muscle-to-fat ratio correlated with better therapeutic response. After 8 weeks of treatment in the study, partial response (PR) to therapy was seen in 2 patients, stable disease (SD) in 9 patients, and progressive disease (PD) in 1 patient. After dapagliflozin discontinuation (and chemotherapy continuation), an additional 7 patients developed the progressive disease in the subsequent scans measured by increased lesion size as well as the development of new lesions. Quantitative imaging assessment was supported by plasma CA19-9 tumor marker measurements. CONCLUSIONS Dapagliflozin is well-tolerated and was associated with high compliance in patients with advanced, inoperable PDAC. Overall favorable changes in tumor response and plasma biomarkers suggest it may have efficacy against PDAC, warranting further investigation.
Collapse
Affiliation(s)
- Lauren K Park
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine in St. Louis, Mail Stop Code: 8131, 660 S. Euclid Ave., Saint Louis, MO, 63110, USA
| | - Kian-Huat Lim
- Department of Medicine, Oncology Division, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jonas Volkman
- Department of Medicine, Oncology Division, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Mina Abdiannia
- Department of Medicine, Oncology Division, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Hannah Johnston
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Mail Stop Code: 8131, 4559 Scott Ave., St. Louis, MO, 63110, USA
| | - Zack Nigogosyan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Mail Stop Code: 8131, 4559 Scott Ave., St. Louis, MO, 63110, USA
| | - Marilyn J Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Mail Stop Code: 8131, 4559 Scott Ave., St. Louis, MO, 63110, USA
| | - Janet B McGill
- Department of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Alexis M McKee
- Department of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Maamoun Salam
- Department of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Rong M Zhang
- Department of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Da Ma
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Karteek Popuri
- Department of Computer Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | - Mirza Faisal Beg
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - William G Hawkins
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Linda R Peterson
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine in St. Louis, Mail Stop Code: 8131, 660 S. Euclid Ave., Saint Louis, MO, 63110, USA.
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Mail Stop Code: 8131, 4559 Scott Ave., St. Louis, MO, 63110, USA.
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Mail Stop Code: 8131, 4559 Scott Ave., St. Louis, MO, 63110, USA.
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| |
Collapse
|
7
|
Bougard M, Barbieux J, Goulin J, Parot-Schinkel E, Vielle B, Lermite E. The TPA score (total psoas muscle area) is the best marker for preoperative measurement of pre-sarcopenia in pancreatic surgery. J Visc Surg 2023; 160:4-11. [PMID: 35760669 DOI: 10.1016/j.jviscsurg.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pre-sarcopenia, defined by the loss of muscle mass, is significantly associated with an increased risk of postoperative complications in digestive surgery, particularly pancreatic resection. The five predominant markers of sarcopenia are: psoas muscle area (TPA), intramuscular adipose tissue content (IMAC), Average Hounsfield Unit Calculation (HUAC), Skeletal Muscle Mass Index (MMI), and the ratio between visceral adipose tissue area and muscle surface area (VFA/TAMA). No standard reference marker has been determined. MATERIAL AND METHODS This retrospective cohort included patients who underwent pancreatic resection at the University Hospital of Angers between January 2008 and June 2017. The goal was to determine the marker that was most significantly associated with morbidity and mortality in pancreatic surgery. The secondary objective was to determine the characteristics of pre-sarcopenic patients. RESULTS The TPA score is the most sensitive marker for identifying patients at highest risk for immediate complications (P=0.008), proving far more sensitive than MMI (P=0.02), HUAC (P=0.34), IMAC (P=1), or VFA/TAMA (P=0.42). Postoperative mortality was 3.3% (n=5), morbidity was 63.8% (n=97). Pre-sarcopenic patients, as identified by the TPA index had significantly more immediate complications (71.2% versus 49.5%, P=0.008), in particular, more gastroparesis (P=0.02) and pancreatic fistula (P=0.03). CONCLUSION In patients requiring pancreatic surgery, the prevalence of pre-sarcopenia is high and seems to be associated with a greater risk of immediate postoperative complications. The TPA score seems to be the most sensitive marker for detecting pre-sarcopenia. Evaluation of TPA preoperatively would make it possible to identify priority patients a priori who might benefit from pre-habilitation programs.
Collapse
Affiliation(s)
- M Bougard
- Digestive Surgery Department, CHU d'Angers, 49933 Angers cedex 9, France.
| | - J Barbieux
- Digestive Surgery Department, centre hospitalier Le Mans, 72000 Le Mans, France
| | - J Goulin
- Digestive Surgery Department, CHU d'Angers, 49933 Angers cedex 9, France
| | - E Parot-Schinkel
- Department of Biostatistics and Methodology, CHU d'Angers, 49933 Angers cedex 9, France
| | - B Vielle
- Department of Biostatistics and Methodology, CHU d'Angers, 49933 Angers cedex 9, France
| | - E Lermite
- Digestive Surgery Department, CHU d'Angers, 49933 Angers cedex 9, France
| |
Collapse
|
8
|
Wood N, Morton M, Shah SN, Yao M, Barnard H, Tewari S, Suresh A, Kollikonda S, AlHilli MM. Association between CT-based body composition assessment and patient outcomes during neoadjuvant chemotherapy for epithelial ovarian cancer. Gynecol Oncol 2023; 169:55-63. [PMID: 36508759 DOI: 10.1016/j.ygyno.2022.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to characterize the body composition of patients undergoing neoadjuvant chemotherapy (NACT) for epithelial ovarian cancer (EOC), identify factors associated with sarcopenia at diagnosis, and evaluate the impact of pretreatment sarcopenia and changes in body composition parameters during therapy on perioperative and disease-related outcomes. METHODS Patients undergoing NACT for EOC between 2008 and 2020 were identified. Pre-treatment and post-treatment contrast-enhanced CT scans were reviewed to determine skeletal muscle index (SMI) and visceral adipose tissue (VAT) area at the mid-fourth lumbar vertebral level. SMI and VAT were analyzed for association with clinical and treatment variables. RESULTS 174 patients were identified. Mean pretreatment SMI and VAT were 38.3 cm2/m2 ± 7.9 and 51.2 cm2/m2 ± 34.3, respectively. Comparatively, mean post-treatment SMI and VAT were 37.8 cm2/m2 ± 7.9 and 43.7 cm2/m2 ± 29.7, respectively. Most patients exhibited an overall decrease in SMI from pretreatment to posttreatment scans. Caucasian race, older age, and lower body mass index at diagnosis were associated with lower pretreatment SMI. Lower pre-treatment SMI was associated with lower surgical complexity scores (p < 0.001) and estimated blood loss (p = 0.029). Decrease in SMI after NACT was associated with increased rates of ICU admissions and length of stay. While there was no association between SMI and overall survival (OS) or progression-free survival (PFS), >2% decrease per 100 days in VAT was significantly associated with worse OS. CONCLUSIONS Patients with lower pretreatment SMI tend to undergo less complex surgery than those with higher SMI despite NACT. Decrease in VAT may be a potential indicator of worse OS. Information on body composition can aid in clinical decision making in patients with EOC.
Collapse
Affiliation(s)
- Nicole Wood
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Molly Morton
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Shetal N Shah
- Department of Radiology, Cleveland Clinic, Cleveland, OH, United States of America
| | - Meng Yao
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States of America
| | - Hannah Barnard
- Department of Radiology, Cleveland Clinic, Cleveland, OH, United States of America
| | - Surabhi Tewari
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Abhilash Suresh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Swapna Kollikonda
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Mariam M AlHilli
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States of America; Division of Gynecologic Oncology, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States of America.
| |
Collapse
|
9
|
Gaspar-Figueiredo S, Labgaa I, Demartines N, Schäfer M, Joliat GR. Assessment of the Predictive Value of Preoperative Serum Albumin and Postoperative Albumin Drop (ΔAlb) for Complications after Pancreas Surgery: A Single-Center Cross-Sectional Study. J Clin Med 2023; 12:jcm12030972. [PMID: 36769619 PMCID: PMC9917642 DOI: 10.3390/jcm12030972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Serum albumin has been shown to be predictive of complications after various gastrointestinal operations. The present study aimed to assess whether preoperative serum albumin and serum albumin drop on postoperative day 1 are associated with postoperative complications after pancreatic surgery. METHODS A single-center cross-sectional study was performed. All patients who underwent pancreatectomy between January 2010 and June 2019 and had preoperative serum albumin value and serum albumin value on postoperative day 1 were included. ΔAlb was defined as the difference between preoperative serum albumin and serum albumin on postoperative day 1. Binary logistic regressions were performed to determine independent predictors of postoperative complications. RESULTS A total of 185 patients were included. Pancreatoduodenectomies were performed in 133 cases, left pancreatectomies in 36, and other pancreas operations in 16. The preoperative serum albumin value was found to be an independent predictor of complications (OR 0.9, 95%CI 0.9-1.0, p = 0.041), whereas ΔAlb was not significantly associated with postoperative complications (OR 1.0, 95%CI 0.9-1.1, p = 0.787). The threshold of 44.5 g/L for preoperative albumin level was found to have the highest combined sensitivity and specificity based on the maximum Youden index. Patients with preoperative albumin < 44.5 g/L had a higher incidence of postoperative complications and higher median comprehensive complication index than patients with preoperative albumin ≥ 44.5 g/L. CONCLUSIONS This study highlighted that preoperative serum albumin is an independent predictor of postoperative complications after pancreas surgery.
Collapse
Affiliation(s)
- Sérgio Gaspar-Figueiredo
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Ismail Labgaa
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Correspondence: (N.D.); (G.-R.J.); Tel.: +41-21-314-24-00 (N.D.); +41-79-556-42-93 (G.-R.J.); Fax: +41-21-314-23-11 (N.D. & G.-R.J.)
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
- Correspondence: (N.D.); (G.-R.J.); Tel.: +41-21-314-24-00 (N.D.); +41-79-556-42-93 (G.-R.J.); Fax: +41-21-314-23-11 (N.D. & G.-R.J.)
| |
Collapse
|
10
|
Biesel EA, Chikhladze S, Ruess DA, Hopt UT, Fichtner-Feigl S, Wittel UA. Stent-Associated Infectious Complications After Pancreatoduodenectomies Can Be Prevented by Perioperative Antibiotic Therapy: An Analysis of Single-Center Standards. Pancreas 2022; 51:1140-1145. [PMID: 37078937 DOI: 10.1097/mpa.0000000000002166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES Perioperative morbidity after pancreatoduodenectomies is still high. One potentially responsible factor is the insertion of bile duct stents before surgery. In our single-center study, we evaluated the influence of preoperative bile duct stenting combined with perioperative antibiotic therapy versus primary surgery in carcinoma patients. METHODS Clinical data of 973 patients undergoing pancreatoduodenectomy at the University Hospital Freiburg from 2002 to 2018 were explored retrospectively. Postoperative pancreatic fistula, delayed gastric emptying (DGE), and postpancreatectomy hemorrhage (PPH) were graded by current international definitions. Patients with pancreatic ductal adenocarcinoma or periampullary carcinoma were included. RESULTS We included 634 patients of whom 372 (58.7%) were treated with preoperative bile duct stenting. No difference concerning postoperative pancreatic fistula was observed (P = 0.479). We found more wound infections (stent 18.4%, no stent 11.1%, P = 0.008) but a significantly lower rate of PPH and DGE in stented patients (PPH 7.5% vs 11.9%, P = 0.044; DGE 16.5% vs 22.5%, P = 0.039). Surprisingly, intra-abdominal abscesses were reduced in stented patients (9.4% vs 15.0%, P = 0.022), just as insufficiencies of the biliodigestive anastomosis (P = 0.021). CONCLUSIONS Perioperative antibiotic therapy seems to reduce the risk for severe intra-abdominal infectious complications in stent-bearing patients.
Collapse
Affiliation(s)
- Esther A Biesel
- From the Department of General and Visceral Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | | | | | | | | | | |
Collapse
|
11
|
Dunne RF, Roeland EJ. The Interplay Among Pancreatic Cancer, Cachexia, Body Composition, and Diabetes. Hematol Oncol Clin North Am 2022; 36:897-910. [PMID: 36154783 DOI: 10.1016/j.hoc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is associated with complex changes in body composition. Visceral obesity and type 2 diabetes mellitus are established risk factors for developing PDAC; however, clinical and metabolic features of PDAC commonly lead to cancer cachexia, a hypermetabolic syndrome characterized by weight loss secondary to muscle and adipose tissue wasting. Reduction in muscle mass in patients with PDAC is associated with poorer survival in patients undergoing surgical resection and increased chemotherapy toxicity. Although no standardized treatment exists, a multidisciplinary, tailored, symptom-based approach is recommended to improve outcomes and quality of life for patients with PDAC and cachexia.
Collapse
Affiliation(s)
- Richard F Dunne
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
| | - Eric J Roeland
- Division of Hematology/Oncology, Oregon Health and Science University, Knight Cancer Institute, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| |
Collapse
|
12
|
Wang P, Wang S, Ma Y, Li H, Liu Z, Lin G, Li X, Yang F, Qiu M. Sarcopenic obesity and therapeutic outcomes in gastrointestinal surgical oncology: A meta-analysis. Front Nutr 2022; 9:921817. [PMID: 35938099 PMCID: PMC9355157 DOI: 10.3389/fnut.2022.921817] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Sarcopenic obesity (SO) has been indicated as a scientific and clinical priority in oncology. This meta-analysis aimed to investigate the impacts of preoperative SO on therapeutic outcomes in gastrointestinal surgical oncology. Methods We searched the PubMed, EMBASE, and Cochrane Library databases through March 4th 2022 to identify cohort studies. Endpoints included postoperative complications and survival outcomes. Newcastle Ottawa Scale was used for quality assessment. Heterogeneity and publication bias were assessed. Subgroup analyses and sensitivity analyses were performed. Results Twenty-six studies (8,729 participants) with moderate to good quality were included. The pooled average age was 65.6 [95% confidence interval (CI) 63.7-67.6] years. The significant heterogeneity in SO definition and diagnosis among studies was observed. Patients with SO showed increased incidences of total complications (odds ratio 1.30, 95% CI: 1.03-1.64, P = 0.030) and major complications (Clavien-Dindo grade ≥ IIIa, odds ratio 2.15, 95% CI: 1.39-3.32, P = 0.001). SO was particularly associated with the incidence of cardiac complications, leak complications, and organ/space infection. SO was also predictive of poor overall survival (hazard ratio 1.73, 95% CI: 1.46-2.06, P < 0.001) and disease-free survival (hazard ratio 1.41, 95% CI: 1.20-1.66, P < 0.001). SO defined as sarcopenia in combination with obesity showed greater association with adverse outcomes than that defined as an increased ratio of fat mass to muscle mass. A low prevalence rate of SO (< 10%) was associated with increased significance for adverse outcomes compared to the high prevalence rate of SO (> 20%). Conclusion The SO was associated with increased complications and poor survival in gastrointestinal surgical oncology. Interventions aiming at SO have potentials to promote surgery benefits for patients with gastrointestinal cancers. The heterogeneity in SO definition and diagnosis among studies should be considered when interpreting these findings. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=255286], identifier [CRD42021255286].
Collapse
Affiliation(s)
- Peiyu Wang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Shaodong Wang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Yi Ma
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Haoran Li
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Zheng Liu
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Guihu Lin
- Department of Thoracic Surgery, China Aerospace Science and Industry Corporation 731 Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Mantang Qiu
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| |
Collapse
|
13
|
Perra T, Sotgiu G, Porcu A. Sarcopenia and Risk of Pancreatic Fistula after Pancreatic Surgery: A Systematic Review. J Clin Med 2022; 11:jcm11144144. [PMID: 35887908 PMCID: PMC9319174 DOI: 10.3390/jcm11144144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 12/22/2022] Open
Abstract
Postoperative pancreatic fistula (POPF) is one of the most critical complications after pancreatic surgery. The relationship between sarcopenia and outcomes following this type of surgery is debated. The aim of this review was to assess the impact of sarcopenia on the risk of POPF. A literature search was performed using the PubMed database and the reference lists of relevant articles to identify papers about the impact of sarcopenia on POPF in pancreatic surgery. Twenty-one studies published between 2016 and 2021 with a total of 4068 patients were included. Some studies observed a significant difference in the incidence of POPF between the sarcopenic and non-sarcopenic patients undergoing pancreatoduodenectomy. Interestingly, there was a trend of a lower POPF rate in sarcopenic patients than in non-sarcopenic patients. Only one study included patients undergoing distal pancreatectomy specifically. The role of sarcopenia in surgical outcomes is still unclear. A combination of objective CT measurements could be used to predict POPF. It could be assessed by routine preoperative staging CT and could improve preoperative risk stratification in patients undergoing pancreatic surgery.
Collapse
|
14
|
CT-Derived Body Composition Assessment as a Prognostic Tool in Oncologic Patients: From Opportunistic Research to Artificial Intelligence-Based Clinical Implementation. AJR Am J Roentgenol 2022; 219:671-680. [PMID: 35642760 DOI: 10.2214/ajr.22.27749] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CT-based body composition measures are well established in research settings as prognostic markers in oncologic patients. Numerous retrospective studies have shown the role of objective measurements extracted from abdominal CT images of skeletal muscle, abdominal fat, and bone mineral density in providing more accurate assessments of frailty and cancer cachexia in comparison with traditional clinical methods. Quantitative CT-based measurements of liver fat and aortic atherosclerotic calcification have received relatively less attention in cancer care but also provide prognostic information. Patients with cancer routinely undergo serial CT scans for staging, treatment response, and surveillance, providing the opportunity for performing quantitative body composition assessment as part of routine clinical care. The emergence of fully automated artificial intelligence-based segmentation and quantification tools to replace earlier time-consuming manual and semi-automated methods for body composition analysis will allow these opportunistic measures to transition from the research realm to clinical practice. With continued investigation, the measurements may ultimately be applied to achieve more precise risk stratification as a component of personalized oncologic care.
Collapse
|
15
|
Gastrointestinal Cancer Patient Nutritional Management: From Specific Needs to Novel Epigenetic Dietary Approaches. Nutrients 2022; 14:nu14081542. [PMID: 35458104 PMCID: PMC9024975 DOI: 10.3390/nu14081542] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
Nutritional habits impinge on the health of the gastrointestinal (GI) tract, contributing to GI disorder progression. GI cancer is a widespread and aggressive tumor sensitive to nutritional changes. Indeed, specific nutritional expedients can be adopted to prevent GI cancer onset and to slow down disease activity. Moreover, the patient’s nutritional status impacts prognosis, quality of life, and chemotherapy tolerance. These patients encounter the highest frequency of malnourishment risk, a condition that can progressively evolve into cachexia. Clinical studies dealing with this topic stressed the importance of nutritional counseling and put under the spotlight nutrient delivery, the type of nutrient supplementation, and timing for the start of nutritional management. A medical practitioner well-prepared on the topic of nutrition and cancer should operate in the clinical team dedicated to these oncological patients. This specific expertise needs to be implemented as soon as possible to adopt nutritional interventions and establish a proper patient-tailored dietary regimen. The nutritional gap closure should be prompt during anticancer treatment to stabilize weight loss, improve treatment tolerability, and ameliorate survival rate. Recently, novel nutritional approaches were investigated to target the bidirectional link between epigenetics and metabolism, whose alteration supports the onset, progression, and therapeutic response of GI cancer patients.
Collapse
|
16
|
Low skeletal muscle index and myosteatosis as predictors of mortality in critically ill surgical patients. Nutrition 2022; 101:111687. [DOI: 10.1016/j.nut.2022.111687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
|
17
|
Angrisani M, Ceresoli M, Ippolito D, Pagni F, Gandola D, Seminati D, Casati G, Sironi S, Braga M, Roccamatisi L, Uggeri F, Sandini M, Gianotti L. Estimating Fatty Pancreas-A Preoperative Bedside Assessment by Bioelectric Impedance Analysis: Implications for Pancreatic Surgery. Pancreas 2022; 51:345-350. [PMID: 35695762 DOI: 10.1097/mpa.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate whether fatty pancreas could be estimated by fat mass measurement by preoperative bioelectric impedance analysis. Preoperative computed tomography scan and pathologic evaluation were used as validation methods. Moreover, the 3 methodologies were tested for their ability in predicting postoperative pancreatic fistula. METHODS Seventy-five patients who underwent pancreatic resection were analyzed. Preoperative computed tomography attenuation in Hounsfield unit (CT-HU) was used to assess fatty pancreas. Bioelectric impedance analysis was performed the day before surgery and fat mass index (FMI) was calculated. Pancreatic steatosis was assessed by pathologists at the line of surgical transection. The ability of the methods in predicting postoperative pancreatic fistula was evaluated by the area under the receiver operating characteristics curves. RESULTS There was a strong correlation between CT-HU values and grade of pancreatic steatosis evaluated at histology ( r = -0.852, P < 0.001) and a moderate correlation between FMI and histologic pancreatic steatosis ( r = 0.612, P < 0.001) and between CT-HU value and FMI ( r = -0.659, P < 0.001) values. The area under the curve (95% confidence interval) was 0.942 (0.879-1) for histology, 0.924 (0.844-1) for CT-HU, and 0.884 (0.778-0.990) for FMI. CONCLUSIONS Bioelectric impedance analysis represents a valid alternative to assess pancreatic steatosis.
Collapse
|
18
|
Computed tomography reference values for visceral obesity and increased metabolic risk in a Caucasian cohort. Clin Nutr ESPEN 2022; 48:408-413. [DOI: 10.1016/j.clnesp.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/17/2021] [Accepted: 01/10/2022] [Indexed: 12/28/2022]
|
19
|
Scafoglieri A, Van den Broeck J, Cattrysse E, Bautmans I, Heymsfield SB. Non-linear Associations Between Visceral Adipose Tissue Distribution and Anthropometry-Based Estimates of Visceral Adiposity. Front Nutr 2022; 9:825630. [PMID: 35399665 PMCID: PMC8987197 DOI: 10.3389/fnut.2022.825630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRecent evidence suggests that excess visceral adipose tissue (VAT) is associated with future loss of subcutaneous adipose tissue (SAT) and skeletal muscle (SM) with aging. In clinical settings (abdominal) circumferences are commonly used to estimate body composition (BC). We aimed to study the linearity of VAT distribution ratios (i.e., VAT/SAT ratio and VAT/SM ratio), waist-to-hip ratio (WHR) and waist circumference (WC) with age and the relationship of VAT distribution ratios with anthropometry (i.e., WHR and WC).Materials and MethodsBC was determined using whole body magnetic resonance imaging in a large multi-ethnic group of 419 adults (42% white, 30% black, 15% Hispanic, 13% Asian, 1% other) with a BMI ranging from 15.9 to 40.8kg/m2. Linear and non-linear regression analysis was used to examine the linearity of VAT distribution ratios and anthropometry from 18 to 88 years. The relation between VAT distribution ratios and anthropometry was assessed separately.ResultsIn both sexes non-linear relationships were found between BC estimates and age, and between BC measures mutually. The ratios of VAT/SAT and VAT/SM showed quadratic relationships with age. VAT distribution ratios showed exponential or quadratic relationships with anthropometry with coefficients of determination ranging between 18 and 55%.ConclusionIn both sexes, VAT distribution ratios showed curvilinear relationships with age and with anthropometry. Given the sex differences in VAT distribution ratios, WHR and WC represent different BC proportions in men and women. These results emphasize the challenge when interpreting changes in BC based upon linear extrapolations in clinical practice.
Collapse
Affiliation(s)
- Aldo Scafoglieri
- Experimental Anatomy Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Frailty in Aging Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- *Correspondence: Aldo Scafoglieri,
| | - Jona Van den Broeck
- Experimental Anatomy Research Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erik Cattrysse
- Experimental Anatomy Research Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Bautmans
- Frailty in Aging Research Department, Vrije Universiteit Brussel, Brussels, Belgium
| | | |
Collapse
|
20
|
Sarcopenic obesity: what about in cancer setting? Nutrition 2022; 98:111624. [DOI: 10.1016/j.nut.2022.111624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 11/20/2022]
|
21
|
Thresholds of visceral fat area and percent of body fat to define sarcopenic obesity and its clinical consequences in Chinese cancer patients. Clin Nutr 2022; 41:737-745. [DOI: 10.1016/j.clnu.2022.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/08/2022] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
|
22
|
Capurso G, Pecorelli N, Burini A, Orsi G, Palumbo D, Macchini M, Mele R, de Cobelli F, Falconi M, Arcidiacono PG, Reni M. The impact of nutritional status on pancreatic cancer therapy. Expert Rev Anticancer Ther 2022; 22:155-167. [PMID: 34989653 DOI: 10.1080/14737140.2022.2026771] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pancreatic Ductal Adenocarcinoma (PDAC) is an aggressive disease with poor outcomes. One of the reasons for the dismal prognosis resides in its impressive ability to alter the nutritional status of patients who develop malnutrition, cachexia, anorexia, and sarcopenia in most cases. The ideal way to measure such changes in PDAC patients, in order to readily identify them and avoid complications or discontinuations of treatment is a relatively unexplored area. In addition, most PDAC patients experience pancreatic exocrine insufficiency (PEI) that contributes to the complex puzzle of malnutrition and that can be treated with Pancreatic Enzyme Replacement Therapy (PERT). AREAS COVERED We review current knowledge on the impact of nutritional status on both surgical and medical treatments for PDAC, reporting available data on the causes of malnutrition, characteristics, and advantages of different tools to investigate nutritional status and possible strategies to improve patient outcomes. EXPERT OPINION All PDAC patients should receive a careful nutritional assessment at diagnosis, and this should be repeated alongside their treatment path. Screening tools and biochemical variables or scores are associated with prognosis, but bioimpedance vector analysis (BIVA) and radiological assessment of body composition seem more accurate in predicting clinical outcomes and postoperative complications.
Collapse
Affiliation(s)
- Gabriele Capurso
- Pancreas Translational & Clinical Research Center, Pancreato-Biliary Endoscopy & Endosonography Division, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicolò Pecorelli
- Pancreas Translational & Clinical Research Center, Division of Pancreatic Surgery, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Alice Burini
- Nutrition Service, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Giulia Orsi
- Pancreas Translational & Clinical Research Center, Oncology Department, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Diego Palumbo
- Pancreas Translational & Clinical Research Center, Department of Radiology & Center for Experimental Imaging, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Marina Macchini
- Pancreas Translational & Clinical Research Center, Oncology Department, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Roberto Mele
- Nutrition Service, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Francesco de Cobelli
- Pancreas Translational & Clinical Research Center, Department of Radiology & Center for Experimental Imaging, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Falconi
- Pancreas Translational & Clinical Research Center, Division of Pancreatic Surgery, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreas Translational & Clinical Research Center, Pancreato-Biliary Endoscopy & Endosonography Division, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Reni
- Pancreas Translational & Clinical Research Center, Oncology Department, San Raffaele Scientific Institute IRCCS, Milan, Italy
| |
Collapse
|
23
|
Dikova TS, Zatsepina AY, Fedorinov DS, Lyadov VK. The impact of sarcopenic obesity on treatment outcomes in gastrointestinal cancer: A systematic review. Clin Nutr ESPEN 2022; 47:135-146. [PMID: 35063193 DOI: 10.1016/j.clnesp.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND GI tract cancer includes a broad spectrum of tumors with generally high prevalence and poor prognosis. Over the past decade sarcopenia (skeletal muscle depletion), myosteatosis, sarcopenic obesity were all shown to have a negative prognostic impact in patients with various malignancies. However, the role of sarcopenic obesity (SO) in patients with GI tumors remains controversial. We systematically reviewed data on the prevalence and prognostic impact of SO for patients with GI malignancies, undergoing surgical and/or chemotherapeutical treatment. METHODS This study was conducted in adherence to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were searched for relevant original studies published between January 2008 to December 2020 reporting postoperative morbidity and mortality, long-term survival and toxicity after chemotherapeutical treatment in SO patients with GI cancer. RESULTS Twenty-two studies comprising 8571 patients were included. The percentage of SO patients ranged from 2.6% to 51%. The association between SO and outcomes of interest was inconsistent because of various cut-offs used to define sarcopenia and obesity. However, SO was significantly associated with the occurrence of major postoperative complications in five studies. In contrast, three studies did not show the impact of SO on postoperative complications. Three studies demonstrated that mortality rate was significantly higher among patients with SO. Five studies of systematic review revealed a statistically significant influence of SO on overall survival in multivariate analysis. However, only in one of them a significant difference was found between SO and DFS. Three studies evaluated toxicity after chemotherapy and all reported statistically significant negative impact of SO. CONCLUSIONS There is considerable heterogeneity in methods used to define SO in the literature and current data is limited. Standardized terminology and deeper understanding of sarcopenic obesity pathophysiology is needed to further understand the influence of obesity and sarcopenia on the clinical trajectory of patients with GI cancer.
Collapse
Affiliation(s)
- Tatyana Sergeevna Dikova
- Department of Oncology and Palliative Medicine named after Academician I.A. Savitsky, Russian Medical Academy of Continuous Professional Education, Moscow, Russia.
| | - Alina Yurievna Zatsepina
- Department of Oncology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Denis Sergeevich Fedorinov
- Department of Oncology and Palliative Medicine named after Academician I.A. Savitsky, Russian Medical Academy of Continuous Professional Education, Moscow, Russia.
| | - Vladimir Konstantinovich Lyadov
- Head of the Division of Oncology №4, Moscow Clinical Oncology Hospital № 1 of the Moscow Healthcare Department, Moscow, Russia; Associate Professor at the Chair of Oncology and Palliative Medicine named after Academician I.A. Savitsky, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; Head of the Chair of Oncology, Novokuznetsk State Institute for Continuous Medical Education, Novokuznetsk, Russia.
| |
Collapse
|
24
|
Rovesti G, Valoriani F, Rimini M, Bardasi C, Ballarin R, Di Benedetto F, Menozzi R, Dominici M, Spallanzani A. Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board. Nutrients 2021; 13:3522. [PMID: 34684523 PMCID: PMC8537095 DOI: 10.3390/nu13103522] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cancer represents a very challenging disease, with an increasing incidence and an extremely poor prognosis. Peculiar features of this tumor entity are represented by pancreatic exocrine insufficiency and an early and intense nutritional imbalance, leading to the highly prevalent and multifactorial syndrome known as cancer cachexia. Recently, also the concept of sarcopenic obesity has emerged, making the concept of pancreatic cancer malnutrition even more multifaceted and complex. Overall, these nutritional derangements play a pivotal role in contributing to the dismal course of this malignancy. However, their relevance is often underrated and their assessment is rarely applied in clinical daily practice with relevant negative impact for patients' outcome in neoadjuvant, surgical, and metastatic settings. The proper detection and management of pancreatic cancer-related malnutrition syndromes are of primary importance and deserve a specific and multidisciplinary (clinical nutrition, oncology, etc.) approach to improve survival, but also the quality of life. In this context, the introduction of a "Nutritional Oncology Board" in routine daily practice, aimed at assessing an early systematic screening of patients and at implementing nutritional support from the time of disease diagnosis onward seems to be the right path to take.
Collapse
Affiliation(s)
- Giulia Rovesti
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
| | - Filippo Valoriani
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (F.V.); (R.M.)
| | - Margherita Rimini
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
| | - Camilla Bardasi
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
| | - Roberto Ballarin
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of General Surgery, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (R.B.); (F.D.B.)
| | - Fabrizio Di Benedetto
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of General Surgery, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (R.B.); (F.D.B.)
| | - Renata Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (F.V.); (R.M.)
| | - Massimo Dominici
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
| | - Andrea Spallanzani
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
| |
Collapse
|
25
|
Capretti G, Bonifacio C, De Palma C, Nebbia M, Giannitto C, Cancian P, Laino ME, Balzarini L, Papanikolaou N, Savevski V, Zerbi A. A machine learning risk model based on preoperative computed tomography scan to predict postoperative outcomes after pancreatoduodenectomy. Updates Surg 2021; 74:235-243. [PMID: 34596836 DOI: 10.1007/s13304-021-01174-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/20/2021] [Indexed: 11/09/2022]
Abstract
Clinically relevant postoperative pancreatic fistula (CR-POPF) is a life-threatening complication following pancreaticoduodenectomy (PD). Individualized preoperative risk assessment could improve clinical management and prevent or mitigate adverse outcomes. The aim of this study is to develop a machine learning risk model to predict occurrence of CR-POPF after PD from preoperative computed tomography (CT) scans. A total of 100 preoperative high-quality CT scans of consecutive patients who underwent pancreaticoduodenectomy in our institution between 2011 and 2019 were analyzed. Radiomic and morphological features extracted from CT scans related to pancreatic anatomy and patient characteristics were included as variables. These data were then assessed by a machine learning classifier to assess the risk of developing CR-POPF. Among the 100 patients evaluated, 20 had CR-POPF. The predictive model based on logistic regression demonstrated specificity of 0.824 (0.133) and sensitivity of 0.571 (0.337), with an AUC of 0.807 (0.155), PPV of 0.468 (0.310) and NPV of 0.890 (0.084). The performance of the model minimally decreased utilizing a random forest approach, with specificity of 0.914 (0.106), sensitivity of 0.424 (0.346), AUC of 0.749 (0.209), PPV of 0.502 (0.414) and NPV of 0.869 (0.076). Interestingly, using the same data, the model was also able to predict postoperative overall complications and a postoperative length of stay over the median with AUCs of 0.690 (0.209) and 0.709 (0.160), respectively. These findings suggest that preoperative CT scans evaluated by machine learning may provide a novel set of information to help clinicians choose a tailored therapeutic pathway in patients candidated to pancreatoduodenectomy.
Collapse
Affiliation(s)
- Giovanni Capretti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Cristiana Bonifacio
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center-IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Crescenzo De Palma
- Artificial Intelligence Center, Humanitas Clinical and Research Center-IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Martina Nebbia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Caterina Giannitto
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center-IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Pierandrea Cancian
- Artificial Intelligence Center, Humanitas Clinical and Research Center-IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Maria Elena Laino
- Artificial Intelligence Center, Humanitas Clinical and Research Center-IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Luca Balzarini
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center-IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | | | - Victor Savevski
- Artificial Intelligence Center, Humanitas Clinical and Research Center-IRCCS, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| |
Collapse
|
26
|
Lee H, Koh DH. [Obesity and Pancreatobiliary Disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 75:240-245. [PMID: 32448855 DOI: 10.4166/kjg.2020.75.5.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 01/04/2023]
Abstract
Obesity has become a major medical and public health problem worldwide. Recent studies have shown that obesity is a chronic disease that is associated with many diseases, such as gallstone disease, acute pancreatitis, fatty liver, and digestive cancer. Obesity is also a risk factor for the formation of cholesterol gallstones. Clinical and epidemiological studies have suggested that obesity is positively associated with the risk of gallbladder cancer. Obesity may modulate the lipid and endogenous hormones metabolism, affect gallbladder motility, increase the risk of gallstones, and increased the risk of gallbladder cancer. In addition, obesity has been considered a risk factor for pancreatic diseases, including pancreatitis and pancreatic cancer. Obese patients develop systemic and local complications of acute pancreatitis more frequently. Several epidemiologic studies have suggested an association of pancreatic cancer with high body mass and lack of physical activity. This study reviewed the literature on obesity and pancreatobiliary disease in terms of epidemiology and mechanism.
Collapse
Affiliation(s)
- Hoongoo Lee
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Dong Hee Koh
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| |
Collapse
|
27
|
Onoe S, Yokoyama Y, Kokuryo T, Igami T, Mizuno T, Yamaguchi J, Watanabe N, Kawakatsu S, Ebata T. A presurgical prognostic stratification based on nutritional assessment and carbohydrate antigen 19-9 in pancreatic carcinoma: An approach with nonanatomic biomarkers. Surgery 2021; 169:1463-1470. [PMID: 33423799 DOI: 10.1016/j.surg.2020.11.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nutritional status and tumor markers are important prognostic indicators for surgical decisions in pancreatic carcinoma. This study aimed to stratify the probability of surviving pancreatic carcinoma based on systematically chosen nonanatomic biomarkers. METHODS We included 187 consecutive patients that underwent surgical resections for pancreatic carcinoma. We performed multivariable analyses to evaluate prognostic indicators, including 4 blood-test indexes: the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, prognostic nutritional index, and the modified Glasgow prognostic score; and 4 body-composition indexes: the normalized total psoas muscle area, the normalized total elector spine muscle area, the psoas muscle computed tomography value, and the elector spine muscle computed tomography value. RESULTS Poor survival was associated with 2 independent risk factors: neutrophil-to-lymphocyte ratio ≥3.0 (hazard ratio, 1.54) and prognostic nutritional index <36 (hazard ratio, 1.60), and with high carbohydrate antigen 19-9 levels (≥37 IU/mL). The 2 indexes were not significantly associated with clinicopathological factors, including carbohydrate antigen 19-9. Patients with no risk factors had significantly better survival than those with 1 (P = .007) or 2 risk factors (P = .001), and survival was similar in the latter 2 groups (P = .253). A presurgical nonanatomic scoring system (range, 0-2) was constructed: 0 points for no risk factors, 1 point for 1 or 2 nutritional risk factors, and 1 point for carbohydrate antigen 19-9 ≥37 IU/mL. Survival rate at 3 years decreased with increasing scores (76% for score 0, 42% for score 1, and 21% for score 2; all P < .05). CONCLUSION Neutrophil-to-lymphocyte ratio and prognostic nutritional index were independent prognostic risk factors in pancreatic carcinoma and integrating these indexes with carbohydrate antigen 19-9 levels could successfully stratify survival.
Collapse
Affiliation(s)
- Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perioperative Medicine, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshio Kokuryo
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perioperative Medicine, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoji Kawakatsu
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
28
|
Sarcopenia and serum biomarkers of oxidative stress after a 6-month physical activity intervention in women with metastatic breast cancer: results from the ABLE feasibility trial. Breast Cancer Res Treat 2021; 188:601-613. [PMID: 34013451 PMCID: PMC8272711 DOI: 10.1007/s10549-021-06238-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/20/2021] [Indexed: 01/04/2023]
Abstract
Purpose Sarcopenia has been identified as an important prognostic factor for patients with cancer. This study aimed at exploring the potential associations between a 6-month physical activity intervention and muscle characteristics, sarcopenia, oxidative stress and toxicities in patients with metastatic breast cancer. Methods Women newly diagnosed with metastatic breast cancer (N = 49) participated in an unsupervised, personalized, 6-month physical activity intervention with activity tracker. Computerized tomography images at the third lumbar vertebra were analysed at baseline, three months and six months to assess sarcopenia (muscle mass index < 40 cm2/m2) and muscle quality (poor if muscle attenuation < 37.8 Hounsfield Units). Oxidative markers included plasma antioxidant enzymes (catalase, glutathione peroxidase and superoxide dismutase activities), prooxidant enzymes (NADPH oxidase and myeloperoxidase activities) and oxidative stress damage markers (advanced oxidation protein products, malondialdehyde (MDA) and DNA oxidation. Results At baseline 53% (mean age 55 years (SD 10.41)) were sarcopenic and 75% had poor muscle quality. Muscle cross sectional area, skeletal muscle radiodensity, lean body mass remained constant over the six months (p = 0.75, p = 0.07 and p = 0.75 respectively), but differed significantly between sarcopenic and non-sarcopenic patients at baseline and 6-months. Sarcopenic patients at baseline were more likely to have an increase of MDA (p = 0.02) at 6 months. Being sarcopenic during at least one moment during the 6-month study was associated with a higher risk of developing severe toxicities (grade > 2) (p = 0.02). Conclusions This study suggests potential benefits of physical activity for maintenance of muscle mass. Sarcopenia can alter many parameters and disturb the pro and antioxidant balance. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06238-z.
Collapse
|
29
|
Zhou Y, Zhu Y, Dong X, Cao G, Li Y, Fan Y, Chen Q, Cai H, Wu Y. Exosomes Derived from Pancreatic Cancer Cells Induce Osteoclast Differentiation Through the miR125a-5p/TNFRSF1B Pathway. Onco Targets Ther 2021; 14:2727-2739. [PMID: 33907416 PMCID: PMC8064725 DOI: 10.2147/ott.s282319] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/31/2021] [Indexed: 12/31/2022] Open
Abstract
Background Pancreatic cancer (PC) was regarded as the 4th principal cause of cancer-related fatalities in the United States and patients usually suffered from severe nutrition deficiency, muscle wasting, as well as bone loss. In our previous research, we have found that PC-derived exosomes potentially initiate insulin resistance in skeletal muscle cells. However, the role of exosomes in the PC-related bone loss remains unknown. Methods The effect of PC-derived exosomes on the osteoclast differentiation and femoral bone structure in the orthotopic xenograft mouse model were investigated. MiRNA expression profiles were detected and a dual luciferase experiment was conducted to identify the direct target of miRNA. Results Our data showed that PC-derived exosomes significantly induced osteoclast differentiation and increased expression of NFAT2, TRAP, CTSK and MMP-9. The bone volume fraction and trabecular thickness of femur significantly reduced in osteoporotic model. Microarray analyses and luciferase reporter assay showed that the process was, at least partially, mediated by the miR-125a-5p/TNFRSF1B signaling pathways. Conclusion According to the results, novel insights have been claimed the effect of exosomes derived from PC on bone deterioration and explained correlation between PC and cancer-related bone loss.
Collapse
Affiliation(s)
- Yizhao Zhou
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Yi Zhu
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Xin Dong
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Guodong Cao
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Yongzhou Li
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Yiqun Fan
- Department of Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, People's Republic of China
| | - Qing Chen
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Haolei Cai
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Yulian Wu
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| |
Collapse
|
30
|
Roccamatisi L, Gianotti L, Paiella S, Casciani F, De Pastena M, Caccialanza R, Bassi C, Sandini M. Preoperative standardized phase angle at bioimpedance vector analysis predicts the outbreak of antimicrobial-resistant infections after major abdominal oncologic surgery: A prospective trial. Nutrition 2021; 86:111184. [PMID: 33676330 DOI: 10.1016/j.nut.2021.111184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Infectious morbidity is the most common and costly among all surgery-related complications, and infections by multidrug-resistant microorganisms (MDR) are associated with poor outcomes. Derangements of body composition is a recognized risk factor for infections. The aim of this study was to investigate the potential association between specific traits of body composition and the risk of having MDR-related infections. METHODS This was a prospective study with patients scheduled for major abdominal surgery for gastrointestinal cancer. Bioimpedance vector analysis (BIVA), a reliable tool for body composition assessment, was performed the day before the operation. Postoperative complications were collected focusing on resistance patterns and site of infection. Patterns of resistance were compared with BIVA parameters. RESULTS Data from 182 patients suffering from pancreatic (n = 76, 41.7%), rectal (n = 38, 20.9%), gastric (n = 31, 17%), or hepatic (n = 37, 20.3%) malignancy were collected. Overall complications occurred in 108 patients (59%), and in 45 patients (28%) bacterial infections were proven at culture. Of these, 15 (8%) were multidrug-sensitive (MDS), 38 MDR, and 2 extended drug-resistant (XDR) infections. The standardized phase angle measured (SPA) at BIVA was significantly lower in the MDR/XDR infections (-0.02 ± 1.20) than for no infection/MDS (0.56 ± 1.53; P = 0.029). A multivariate analysis showed that SPA was the only independent variable for MDR/XDR infections with an odds ratio of 3.057 (95% confidence interval, 1.354-6903; P = 0.007). The predictive ability of SPA revealed an area under the receiver operating characteristic curve of 0.662, with an optimal threshold of -0.3. CONCLUSIONS In surgical cancer patients, preoperative value of SPA lower than -0.3 is associated with the outbreak of MDR bacterial infections.
Collapse
Affiliation(s)
- Linda Roccamatisi
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy.
| | - Salvatore Paiella
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Fabio Casciani
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Matteo De Pastena
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Marta Sandini
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy; Department of General Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
31
|
Petrolo M, Rangelova E, Toilou M, Hammarqvist F. Body composition, muscle function and biochemical values in patients after pancreatic surgery: An observational study. Clin Nutr 2021; 40:4284-4289. [PMID: 33583661 DOI: 10.1016/j.clnu.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS The complex nature of pancreatic operation makes it a high-risk and technically demanding major abdominal procedure, resulting in early pathophysiological alterations. This study aims to observe changes in body composition, muscle function and biochemical values in patients during the early postoperative days (PODs) following pancreaticoduodenectomy or total pancreatectomy. METHODS Assessment of body composition by bioimpedance spectroscopy, muscle function by peak expiratory flow rate (PEFR) and maximum handgrip strength (HGS), and biochemical values were measured in patients the day before surgery and on PODs 3, 6 and 9. RESULTS Significant changes occurred among 34 patients on POD 3 in body weight +2.3 (0.8-3.6) kg, total body water +2.8 (1.1-5.9) L, extracellular water +2.5 (1.2-3.7) L, intracellular water +1.1 (-0.4-1.9) L, phase angle -1.0 (-1.2 to -0.7)°, PEFR -250.0 (-407.5 to -125.0) L/m and HGS -4.8 (-7.3 to -3.0) kg, C-reactive protein +78.0 (41.0-102.8) mg/L, haemoglobin -34.5 (-45.8 to -26.0) g/L, albumin -12 (-16.5 to -10.0) g/L. CONCLUSIONS Changes in water distribution, phase angle, initial reduced muscle function and altered biochemical values were observed during the first 9 PODs.
Collapse
Affiliation(s)
- Martina Petrolo
- Clinical Nutrition, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
| | - Elena Rangelova
- Clinical Investigation and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden; Department of Upper Abdominal Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Toilou
- Clinical Nutrition, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Folke Hammarqvist
- Department of Trauma and Acute Reparative Medicine, Karolinska University Hospital, CLINTEC, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
32
|
Duan K, Gao X, Wei L, Gong M, Feng B, Zhou J, Zhu D. Skeletal muscle depletion and nutrition support affected postoperative complications in patients who underwent pancreatoduodenectomy. Eur J Clin Nutr 2021; 75:1218-1226. [PMID: 33483631 DOI: 10.1038/s41430-020-00851-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Body composition has been shown closely related to the outcome in surgical patients. The aim of the present study was to investigate whether preoperative skeletal muscle condition and postoperative nutrition would affect major complications in patients underwent pancreaticoduodenectomy (PD). METHODS This retrospective study included 265 patients underwent PD. Body composition data was extracted from the L3 level of the preoperative CT scan. Univariable and multivariable regression analyses were performed to investigate correlations between body composition data and postoperative complications. Furthermore, a subgroup analysis was conducted to explore the relationship between postoperative nutrition strategy and the outcome. RESULTS Of all the 265 patients, major complications occurred in 81 patients (30.6%). Cutoff values for skeletal muscle depletion were defined by ROC curve analysis from postoperative complications in skeletal muscle index (SMI) (male 47.32 cm2/m2 and female 40.65 cm2/m2). Univariable analysis and multivariable regression revealed age (OR 1.49, 95% CI 1.22-1.83, p = 0.026), SMI (OR 0.77, 95% CI 0.51-0.94, p = 0.015) and skeletal muscle density (SMD) (OR 0.85, 95% CI 0.64-1.03, p = 0.029) were independent predictors for major complications. Subgroup analysis showed the initial parenteral nutrition time (IPNT) (OR 1.89, 95% CI 1.43-2.49, p = 0.032) and average protein delivery (APD) (OR 0.76, 95% CI 0.53-0.89, p = 0.021) were significantly associated with major complications in patients with lower SMI. CONCLUSIONS Preoperative skeletal muscle index and density were independently associated with major complications in patients underwent PD. In patients with lower SMI, early parenteral nutrition and higher protein delivery were related to better outcome.
Collapse
Affiliation(s)
- Kaipeng Duan
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Xin Gao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Luxin Wei
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Mengting Gong
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Bin Feng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Jin Zhou
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China.
| | - Dongming Zhu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China.
| |
Collapse
|
33
|
Ryu Y, Shin SH, Kim JH, Jeong WK, Park DJ, Kim N, Heo JS, Choi DW, Han IW. The effects of sarcopenia and sarcopenic obesity after pancreaticoduodenectomy in patients with pancreatic head cancer. HPB (Oxford) 2020; 22:1782-1792. [PMID: 32354655 DOI: 10.1016/j.hpb.2020.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 09/05/2019] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recently, several studies have reported that sarcopenia and sarcopenic obesity (SO) could worsen postoperative complications after PD. This study aims to evaluate the effects of preoperative sarcopenia and SO following PD in pancreatic head cancer (PHD). METHODS Preoperative sarcopenia and SO were assessed in 548 patients undergoing PD for PHC at Samsung Medical Centre between 2007 and 2016. The visceral adipose tissue-to-skeletal muscle ratio was calculated from cross-sectional visceral fat and muscle areas on preoperative CT images. The overall survival (OS) and rate of clinically relevant postoperative pancreatic fistula (CR-POPF) among postoperative complications were extracted from prospectively maintained databases. RESULTS Preoperative sarcopenia was present in 252 patients (45.9%). The 5-year survival rates of patients with non-sarcopenia and sarcopenia were 28.4% and 23.4% (p = 0.046). Preoperative SO was present in 202 patients (36.9%). After multivariable analysis, the presence of SO was the only independent risk factor for CR-POPF (p = 0.018). CONCLUSION Sarcopenia can be a risk factor affecting decreased OS after PD in patients with PHC. SO is the only predictive factor for CR-POPF after PD in patients with PHC. More observational studies are needed to evaluate the effects of sarcopenia and SO on survival after PD.
Collapse
Affiliation(s)
- Youngju Ryu
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang H Shin
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Hun Kim
- Department of Radiology and Centre for Imaging Science, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Woo K Jeong
- Department of Radiology and Centre for Imaging Science, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae J Park
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Naru Kim
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin S Heo
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong W Choi
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - In W Han
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
34
|
Kałędkiewicz E, Milewska M, Panczyk M, Szostak-Węgierek D. The Prevalence of Sarcopenic Obesity in Postmenopausal Women with a History of Breast Cancer Depending on Adopted Methodology - A Case-Control Study. J Multidiscip Healthc 2020; 13:1749-1758. [PMID: 33281453 PMCID: PMC7708830 DOI: 10.2147/jmdh.s274660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/22/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Sarcopenic obesity (SO) is characterized as the cooccurrence of sarcopenia and obesity. It is associated with many adverse health consequences, also in oncological patients. The study aimed to assess the prevalence of SO in postmenopausal women with a history of breast cancer depending on adopted methodology. Materials and Methods The case–control study enrolled 103 women over the age of 50 with a history of breast cancer, including women who completed oncological treatment and had remained in remission for at least 5 years (group I, n=78) and women in whom the disease recurred (group II, n=25). The control group included women with no history of breast cancer (group III, n=73). Results In group II sarcopenia occurred significantly more commonly compared to both group I and the control group (for the skeletal muscle index (SMI) ≤29.20%: 13 (52%) in group II vs 16 (20.5%) in group I, p=0.004 and 3 (4.1%) in group III, p<0.001; for SMI ≤26.60%: 10 (40%) in group II vs 9 (11.5%) in group I, p=0.003 and 3 (4.1%) in group III, p<0.001; for SMI ≤33.87%: 17 (68%) in group II vs 21 (26.9%) in group I, p<0.001 and 5 (6.8%) in group III, p<0.001). Depending on the assessment criteria, SO was diagnosed in 0–11.5% of cases in group I, 0–40% of cases in group II and 0–4.1% in the control group. Intergroup differences were not statistically significant, irrespective of the adopted pair of diagnostic criteria. The highest detectability of SO was observed when SMI was combined with each of the diagnostic criteria for obesity used. Discussion SO diagnosis based on the percentage of fatty tissue mass in the body of >38% and SMI value were associated with a higher detection rate of SO in each study group, regardless of the adopted cut-off value. Similar results were obtained in each analyzed group when using the remaining diagnostic criteria for obesity and SMI value, regardless of the cut-off value.
Collapse
Affiliation(s)
- Emilia Kałędkiewicz
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Milewska
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
35
|
Drozdov ES, Koshel AP, Rodionova OV, Dibina TV, Klokov SS. [Predictors of external pancreatic fistulae after pancreatic resection]. Khirurgiia (Mosk) 2020:107-114. [PMID: 33210516 DOI: 10.17116/hirurgia2020111107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite a significant decrease in postoperative mortality after pancreatic resections in recent years (5.2-15% after pancreatoduodenectomy and about 5% after distal pancreatectomy), incidence of postoperative complications remains high (30-50% and 22-50%, respectively). Postoperative pancreatic fistula is one of the most common and formidable complications. Currently, most authors use the classification proposed by the International Study Group for Pancreatic Fistula (biochemical failure, fistula type B and C). Prediction of the risk of postoperative fistula is still a complex and unresolved problem of modern surgical pancreatology. According to the literature, the main risk factors of postoperative pancreatic fistulae are obesity and high body mass index, concomitant cardiovascular diseases, no neoadjuvant chemo- and radiotherapy, soft pancreatic texture, narrow pancreatic duct, no fibrotic changes in parenchyma, adipose infiltration of the pancreas, advanced intraoperative blood loss, as well as center experience. Most often, magnetic resonance imaging, computed tomography, ultrasound elastography and various multivariate risk assessment systems are used to estimate the risk of pancreatic fistulae. However, a generally accepted technique does not exist. This manuscript is devoted to analysis of risk factors of postoperative pancreatic fistulae and diagnostic methods for assessment of this risk.
Collapse
Affiliation(s)
- E S Drozdov
- Siberian State Medical University, Tomsk, Russia.,Tomsk Regional Oncology Hospital, Tomsk, Russia
| | - A P Koshel
- Siberian State Medical University, Tomsk, Russia.,Alperovich Tomsk City Clinical Hospital No. 3, Tomsk, Russia
| | | | | | - S S Klokov
- Siberian State Medical University, Tomsk, Russia.,Zherlov Medical Center, Seversk, Russia
| |
Collapse
|
36
|
Wang H, Jin J, Zhu F, Peng F, Wang M, Qin R. The ratio of abdominal depth to body mass index is a preoperative predictor of postoperative complications after laparoscopic pancreaticoduodenectomy: a retrospective propensity score matched analysis. Surg Endosc 2020; 35:6472-6480. [PMID: 33156385 DOI: 10.1007/s00464-020-08140-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Postoperative complication rates after laparoscopic pancreaticoduodenectomy (LPD) remain high despite improvements in perioperative management. Measurements on computed tomography imaging of intra-abdominal tissue have not been thoroughly investigated as predictors of mortality and morbidity following LPD. The aim of this study was to assess whether the ratio of abdominal depth and body mass index (AD/BMI ratio) could predict postoperative complications following LPD. METHODS We retrospectively analyzed 231 patients who underwent LPD and had a computed tomography scan between 2014 and 2018. Demographic, radiologic, and pathologic data were correlated to the occurrence of postoperative complications. Propensity score matching was performed to minimize selection biases associated with the comparison of retrospective data between the high and low AD/BMI ratio groups. Univariate and multivariate analyses were also performed to assess the risk factors for postoperative complications. RESULTS Of the 102 patients identified for propensity score matching analysis, 29 patients (28.4%) experienced postoperative complications. Patients with a high AD/BMI ratio had a higher prevalence of overall complications (45.1% vs. 11.8%, P < 0.001), postoperative pancreatic fistula (17.6% vs. 2.00%, P = 0.008), delayed gastric emptying (33.3% vs. 3.90%, P < 0.001), and intra-abdominal abscess (17.6% vs. 0, P = 0.002). In the multivariate analysis, an AD/BMI ratio greater than 2.7 (m3/[kg·103]; OR = 6.16, 95% confidence interval [1.04-36.4], P = 0.045) was the only independent predictive factor of postoperative complications. CONCLUSIONS The preoperative AD/BMI ratio is a predictor of postoperative complications following LPD.
Collapse
Affiliation(s)
- Hebin Wang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Hubei, 430030, Wuhan, China
| | - Jikuan Jin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Hubei, 430030, Wuhan, China
| | - Feng Zhu
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Hubei, 430030, Wuhan, China
| | - Feng Peng
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Hubei, 430030, Wuhan, China
| | - Min Wang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Hubei, 430030, Wuhan, China
| | - Renyi Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Hubei, 430030, Wuhan, China.
| |
Collapse
|
37
|
Chi ZC. Research status and prgoress of nonalcoholic fatty pancreatic disease. Shijie Huaren Xiaohua Zazhi 2020; 28:933-950. [DOI: 10.11569/wcjd.v28.i19.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty pancreatic disease (NAFPD) is a disease characterized by an increase in pancreatic fat accumulation. It is a component of the metabolic syndrome and often coexists with nonalcoholic fatty liver disease. Once the diagnosis is established, it is closely related to acute and chronic pancreatitis, type 2 diabetes mellitus, pancreatic fibrosis, and pancreatic cancer. In recent years, it has been confirmed that NAFPD is closely related to cardiovascular disease, liver fibrosis, and liver cancer. The prevalence of NAFPD ranges between 11% and 69%, and increases with age. It is worth noting that the prevalence in obese children is twice as high as that in non-obese children. The high prevalence rate and complexity of the disease have aroused people's high attention. Therefore, to improve the understanding of NAFPD, fully understand the clinical significance of NAFPD, and further study its pathogenesis, diagnosis, and treatment require the collaboration and joint efforts of multiple disciplines, including hepatopathy, gastroenterology, endocrine metabolism, cardiovascular disease, imaging, pathology, and others. In this paper, we review the clinical significance, pathogenesis, and imaging diagnosis of NAFPD and propose our personal understanding of the key points in future research.
Collapse
Affiliation(s)
- Zhao-Chun Chi
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao 266011, Shandong Province, China
| |
Collapse
|
38
|
Onishi S, Tajika M, Tanaka T, Yamada K, Abe T, Higaki E, Hosoi T, Inaba Y, Muro K, Shimizu M, Niwa Y. Prognostic Impact of Sarcopenic Obesity after Neoadjuvant Chemotherapy Followed by Surgery in Elderly Patients with Esophageal Squamous Cell Carcinoma. J Clin Med 2020; 9:E2974. [PMID: 32942595 PMCID: PMC7563329 DOI: 10.3390/jcm9092974] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022] Open
Abstract
We evaluated the impact of body composition on clinical outcomes after neoadjuvant chemotherapy (NAC) followed by surgery for elderly cStage II/III esophageal squamous cell carcinoma (ESCC). Ninety-one patients ≥70 years old and 116 patients <70 years old with ECSS who underwent NAC between January 2013 and June 2018 at the Aichi Cancer Center were included. Body composition as assessed from computed tomography (CT), American Society of Anesthesiologists physical status (ASA-PS), and subjective global assessment (SGA) was assessed before initiation of NAC. Although elderly patients showed significantly poorer ASA-PS (p < 0.01) and SGA (p < 0.01), and significantly more frequent history of malignancy (p < 0.05), no significant differences were identified in the frequencies of adverse events, postoperative complications, or in cancer-specific survival (p = 0.65, hazard ratio 1.15), or overall survival (p = 0.42, hazard ratio 1.26). However, multivariate analysis identified sarcopenic obesity as the only independent predictor of prognosis in elderly patients. Sarcopenic obesity was associated with higher body mass index (p = 0.04), better SGA (p < 0.01), and lower pre-treatment weight loss (p = 0.03). NAC was as effective and safe for elderly patients without sarcopenic obesity as for young patients. However, diagnosing sarcopenic obesity based on clinical findings is difficult, so the preoperative CT assessment of sarcopenic obesity is important.
Collapse
Affiliation(s)
- Sachiyo Onishi
- Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan; (S.O.); (T.T.); (K.Y.); (Y.N.)
| | - Masahiro Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan; (S.O.); (T.T.); (K.Y.); (Y.N.)
| | - Tsutomu Tanaka
- Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan; (S.O.); (T.T.); (K.Y.); (Y.N.)
| | - Keisaku Yamada
- Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan; (S.O.); (T.T.); (K.Y.); (Y.N.)
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan; (T.A.); (E.H.); (T.H.)
| | - Eiji Higaki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan; (T.A.); (E.H.); (T.H.)
| | - Takahiro Hosoi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan; (T.A.); (E.H.); (T.H.)
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan;
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan;
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan;
| | - Yasumasa Niwa
- Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan; (S.O.); (T.T.); (K.Y.); (Y.N.)
| |
Collapse
|
39
|
Abe T, Amano H, Kobayashi T, Hanada K, Hattori M, Nakahara M, Ohdan H, Noriyuki T. Preoperative anthropomorphic and nutritious status and fistula risk score for predicting clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy. BMC Gastroenterol 2020; 20:264. [PMID: 32770952 PMCID: PMC7414683 DOI: 10.1186/s12876-020-01397-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/22/2020] [Indexed: 01/08/2023] Open
Abstract
Background Postoperative pancreatic fistula (POPF) is a life-threatening postoperative complication. The aim of this study was to evaluate the efficacy of the fistula risk score (FRS) and preoperative body composition factors for predicting the occurrence of clinically relevant POPF (CR-POPF) after pancreaticoduodenectomy (PD). Methods In this study, 136 consecutive patients who underwent PD between 2006 and 2018 were enrolled. The risk factors of CR-POPF (grades B and C) were analyzed. Preoperative visceral adipose tissue area (VATA), skeletal mass index (SMI), and subcutaneous adipose tissue area (SATA) were calculated from computed tomography data. Results The overall 30-day mortality and morbidity rates were 0.7 and 38%, respectively. The incidence rates of grade B and C CR-POPF were 27 and 4%, respectively. A univariate analysis revealed that male sex, habitual smoking, prognostic nutritional index (PNI) < 45, VATA ≥90, VATA/SATA ≥0.9, VATA/SMI ≥ 1.4, and FRS > 4 were significantly associated with the incidence of CR-POPF. A multivariate analysis revealed that PNI < 45, VATA/SMI ≥ 1.4 and FRS > 4 were the independent risk factors of CR-POPF. Conclusions Preoperative anthropomorphic imbalance, PNI, and FRS were independent risk factors for CR-POPF. Patients with high-risk factors should be closely monitored during the postoperative period.
Collapse
Affiliation(s)
- Tomoyuki Abe
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, 722-8508, Japan
| | - Hironobu Amano
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, 722-8508, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan
| | - Minoru Hattori
- Advanced Medical Skills Training Center, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, 722-8508, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, 722-8508, Japan. .,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| |
Collapse
|
40
|
Hirono S, Shimokawa T, Nagakawa Y, Shyr Y, Kawai M, Matsumoto I, Satoi S, Yoshitomi H, Okabayashi T, Motoi F, Amano R, Murakami Y, Hirano S, Kawamoto K, Nakamori S, Shan Y, Kobayashi S, Nitta H, Matsukawa H, Uchiyama K, Hsu C, Kitami C, Yamamoto M, Hwang T, Yamaue H. Risk factors for pancreatic fistula grade C after pancreatoduodenectomy: A large prospective, multicenter Japan‐Taiwan collaboration study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:622-631. [DOI: 10.1002/jhbp.799] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/10/2020] [Accepted: 06/28/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Seiko Hirono
- Second Department of Surgery School of Medicine Wakayama Medical University Wakayama Japan
| | - Toshio Shimokawa
- Clinical Study Support Center School of Medicine Wakayama Medical University Wakayama Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery Tokyo Medical University Tokyo Japan
| | - Yi‐Ming Shyr
- Department of Surgery Taipei Veterans General Hospital National Yang Ming University Taipei Taiwan
| | - Manabu Kawai
- Second Department of Surgery School of Medicine Wakayama Medical University Wakayama Japan
| | - Ippei Matsumoto
- Department of Surgery Kindai University Faculty of Medicine Osaka Japan
| | - Sohei Satoi
- Department of Surgery Kansai Medical University Osaka Japan
| | - Hideyuki Yoshitomi
- Department of General Surgery Graduate School of Medicine Chiba University Chiba Japan
| | - Takehiro Okabayashi
- Division of Hepato‐Biliary Pancreatic Surgery Kochi Health Sciences Center Kochi Japan
| | - Fuyuhiko Motoi
- Department of Surgery Graduate School of Medicine Tohoku University Miyagi Japan
| | - Ryosuke Amano
- Department of Surgical Oncology Graduate School of Medicine Osaka City University Osaka Japan
| | | | - Satoshi Hirano
- Department of Gastroenterological Surgery II Hokkaido University Faculty of Medicine Hokkaido Japan
| | | | - Shoji Nakamori
- Department of Surgery Osaka National Hospital Osaka Japan
| | - Yan‐Shen Shan
- Department of Surgery National Cheng‐Kung University Hospital Institute of Clinical Medicine National Cheng Kung University Tainan Taiwan
| | - Shinjiro Kobayashi
- Division of Gastroenterological and General Surgery St. Marianna University School of Medicine Kanagawa Japan
| | - Hiroyuki Nitta
- Department of Surgery School of Medicine Iwate Medical University Iwate Japan
| | - Hiroyoshi Matsukawa
- Department of Surgery Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan
| | | | - Chih‐Po Hsu
- Department of Surgery Chang Gung Memorial Hospital College of Medicine Chang Gung University Taoyuan City Taiwan
| | - Chie Kitami
- Department of Surgery Nagaoka Chuo General Hospital Niigata Japan
| | - Masakazu Yamamoto
- Institute of Gastroenterology Tokyo Women’s Medical University Tokyo Japan
| | - Tsann‐Long Hwang
- Department of Surgery Chang Gung Memorial Hospital College of Medicine Chang Gung University Taoyuan City Taiwan
| | - Hiroki Yamaue
- Second Department of Surgery School of Medicine Wakayama Medical University Wakayama Japan
| |
Collapse
|
41
|
Duan K, Gao X, Zhu D. The clinical relevance and mechanism of skeletal muscle wasting. Clin Nutr 2020; 40:27-37. [PMID: 32788088 DOI: 10.1016/j.clnu.2020.07.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/15/2020] [Accepted: 07/21/2020] [Indexed: 02/08/2023]
Abstract
Skeletal muscle wasting occurs in both chronic and acute diseases. Increasing evidence has shown this debilitating process is associated with short- and long-term outcomes in critical, cancer and surgical patients. Both muscle quantity and quality, as reflected by the area and density of a given range of attenuation in CT scan, impact the patient prognosis. In addition, ultrasound and bioelectrical impedance analysis (BIA) are also widely used in the assessment of body composition due to their bedside viability and no radioactivity. Mechanism researches have revealed complicated pathways are involved in muscle wasting, which include altered IGF1-Akt-FoxO signaling, elevated levels of myostatin and activin A, activation of NF-κB pathway and glucocorticoid effects. Particularly, central nervous system (CNS) has been proven to participate in regulating muscle wasting in various conditions, such as infection and tumor. Several promising therapeutic agents have been under developing in the treatment of muscle atrophy, such as myostatin antagonist, ghrelin analog, non-steroidal selective androgen receptor modulators (SARMs). Notably, nutritional therapy is still the fundamental support in combating muscle wasting. However, the optimizing and tailored nutrition regimen relies on accurate metabolism measurement and large clinical trials in the future. Here, we will discuss the current understanding of muscle wasting and potential treatment in clinical practice.
Collapse
Affiliation(s)
- Kaipeng Duan
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China
| | - Xin Gao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China
| | - Dongming Zhu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China.
| |
Collapse
|
42
|
Xu JY, Li C, Zhang H, Liu Y, Wei JM. Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy. Risk Manag Healthc Policy 2020; 13:761-770. [PMID: 32753989 PMCID: PMC7358091 DOI: 10.2147/rmhp.s257677] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIM Sarcopenia has been proven to be a risk factor after pancreatoduodenectomy (PD). We aimed to evaluate if decreased psoas muscle area and density shown in CT scan, as measures for sarcopenia, were associated with postoperative major complications and adverse outcomes in patients who underwent PD. PATIENTS AND METHODS We analyzed 152 consecutive patients who underwent open PD. Total psoas area and muscle attenuation were measured on CT images at the level of the third lumbar vertebra. Total psoas area index (TPAI) was calculated, the cut-off values of TPAI were estimated and validated. The relationship between radiographic characters and outcomes was analyzed. RESULTS The optimal cut-off values of TPAI were 4.78 cm2/m2 for males and 3.46 cm2/m2 for females. The values were validated by outcomes with significant differences in the rate of major complications, re-operation, length of stay, and total cost. The prevalence of TPAI-defined sarcopenia and sarcopenic overweight/obesity was 38.8% and 17.1% in total. In multivariate logistic regression, rate of major complications was associated with TPAI [OR=0.605, 95% CI (0.414, 0.883), P=0.009], TPAI-defined sarcopenia [OR=8.256, 95% CI (2.890, 23.583), P=0.000] and sarcopenic overweight/obesity [OR=7.462, 95% CI (2.084, 26.724), P=0.002]; meanwhile, NRS2002-defined nutritional risk and GLIM-defined malnutrition did not show relationship with major complications. CONCLUSION Both sarcopenia and sarcopenic overweight/obesity determined by new TPAI cut-off values were associated with a higher rate of major complications and adverse outcomes in Chinese patients undergoing open PD whereas usual nutritional assessment was not.
Collapse
Affiliation(s)
- Jing-Yong Xu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
| | - Chen Li
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
| | - He Zhang
- Community Health Service Administration Center of Dongcheng District, Beijing100006, People’s Republic of China
| | - Yuan Liu
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
| | - Jun-Min Wei
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
| |
Collapse
|
43
|
Ishii K, Yokoyama Y, Ebata T, Igami T, Mizuno T, Yamaguchi J, Onoe S, Watanabe N, Nagino M. Impact of the preoperative body composition indexes on intraoperative blood loss in patients undergoing pancreatoduodenectomy. Surg Today 2020; 51:52-60. [PMID: 32564145 DOI: 10.1007/s00595-020-02054-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
Abstract
PURPOSES This study sought to identify any significant predictors of blood loss during pancreatoduodenectomy (PD) among preoperative variables, including the body composition indexes. METHODS The preoperative data of patients undergoing PD were retrospectively reviewed. The objective variable was the percentage of blood loss during PD to the estimated circulating blood volume (proportional blood loss: PBL). The circulating blood volume was estimated using Nadler's formula. The total psoas area, average Hounsfield units of psoas area (psoas muscle density: PMD), and visceral to subcutaneous adipose tissue area ratio (VSR) were measured at the third vertebra using preoperative plain computed tomography images. A univariate analysis and multiple linear regression analysis for PBL were conducted using the preoperative variables. RESULTS A total of 415 patients were analyzed. The median PBL was 24.5%. The PMD (coefficient - 0.267; 95% CI - 0.518, - 0.015), VSR (coefficient 2.719; 95% CI 0.238, 5.201), serum albumin level (coefficient - 8.458; 95% CI - 13.02, - 3.898), neoadjuvant therapy (coefficient 9.605; 95% CI 1.722, 17.49), and prothrombin time-international normalized ratio (PT-INR, coefficient 38.63; 95% CI 10.94, 66.31) were independently associated with PBL. CONCLUSIONS The preoperative PMD, VSR, serum albumin level, neoadjuvant therapy, and PT-INR independently affected PBL. These factors could therefore be potential targets to reduce blood loss during PD.
Collapse
Affiliation(s)
- Kenta Ishii
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. .,Division of Perioperative Medicine, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 4668550, Japan.
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Division of Perioperative Medicine, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 4668550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
44
|
The impact of sarcopenia on patients undergoing treatment for pancreatic ductal adenocarcinoma. JOURNAL OF PANCREATOLOGY 2020. [DOI: 10.1097/jp9.0000000000000046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
45
|
Perioperative Interstitial Fluid Expansion Predicts Major Morbidity Following Pancreatic Surgery: Appraisal by Bioimpedance Vector Analysis. Ann Surg 2020; 270:923-929. [PMID: 31592889 DOI: 10.1097/sla.0000000000003536] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate whether perioperative bioimpedance vector analysis (BIVA) predicts the occurrence of surgery-related morbidity. SUMMARY BACKGROUND DATA BIVA is a reliable tool to assess hydration status and compartimentalized fluid distribution. METHODS The BIVA of patients undergoing resection for pancreatic malignancies was prospectively measured on the day prior to surgery and on postoperative day (POD)1. Postoperative morbidity was scored per the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI). RESULTS Out of 249 patients, the overall and major complication rates were 61% and 16.5% respectively. The median CCI was 24 (IQR 0.0-24.2), and 24 patients (9.6%) had a complication burden with CCI≥40. At baseline the impedance vectors of severe complicated patients were shorter compared to the vectors of uncomplicated patients only for the female subgroup (P=0.016). The preoperative extracellular water (ECW) was significantly higher in patients who experienced severe morbidity according to the CDC or not [19.4L (17.5-22.0) vs. 18.2L (15.6-20.6), P=0.009, respectively] and CCI≥40, or not [20.3L (18.5-22.7) vs. 18.3L (15.6-20.6), P=0.002, respectively]. The hydration index on POD1 was significantly higher in patients who experienced major complications than in uncomplicated patients (P=0.020 and P=0.025 for CDC and CCI, respectively).At a linear regression model, age (β=0.14, P=0.035), sex female (β=0.40, P<0.001), BMI (β=0.30, P<0.001), and malnutrition (β=0.14, P=0.037) were independent predictors of postoperative ECW. CONCLUSION The amount of extracellular fluid accumulation predicts major morbidity after pancreatic surgery. Female, obese and malnourished patients were at high risk of extracellular fluid accumulation.
Collapse
|
46
|
Permanent Pancreatic Duct Occlusion With Neoprene-based Glue Injection After Pancreatoduodenectomy at High Risk of Pancreatic Fistula: A Prospective Clinical Study. Ann Surg 2020; 270:791-798. [PMID: 31567180 PMCID: PMC6867669 DOI: 10.1097/sla.0000000000003514] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this study was to assess safety and efficacy of pancreatic duct occlusion (PDO) with neoprene-based glue in selected patients undergoing pancreatoduodenectomy (PD) at high risk of postoperative pancreatic fistula (POPF).
Collapse
|
47
|
Kamo N, Kaido T, Miyachi Y, Iwamura S, Yao S, Shirai H, Yagi S, Uemoto S. Preoperative abnormal body composition is closely related to bacteremia after living donor liver transplantation. Nutrition 2020; 77:110798. [PMID: 32446184 DOI: 10.1016/j.nut.2020.110798] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/01/2020] [Accepted: 02/13/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Infection is the most critical cause of early death after liver transplantation (LT). However, the effect of preoperative body composition on bacteremia after LT is unclear. The aim of this study was to examine the effects of preoperative body composition on bacteremia after living donor LT (LDLT). METHODS The study comprised 277 patients who underwent LDLT at Kyoto University, Kyoto, Japan, between January 2008 and June 2016. We evaluated body composition parameters including skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR) using preoperative plain computed tomography at the L3 level. We compared the incidence of bacteremia, species, period of antibiotic administration, mortality due to bacteremia, and survival rates according to the number of abnormal body composition factors (low SMI, high IMAC, and high VSR). Moreover, risk factors for post-transplant bacteremia were examined. RESULTS Incidence of bacteremia was significantly higher in patients with three abnormal factors (47.1%), two factors (42%), or a single factor (37%) than in patients with no factors (22.5%; P = 0.027). Species of bacteremia did not differ significantly among the four groups. The period of antibiotic administration was significantly shorter (P = 0.039) and mortality of patients with bacteremia and survival rates were significantly better (P < 0.001, each) in patients with no factors. Multivariate analysis identified ABO incompatibility (P = 0.002) and low SMI (P = 0.045) as independent risk factors for bacteremia after LT. CONCLUSION Preoperative abnormal body composition was closely related to bacteremia after LDLT.
Collapse
Affiliation(s)
- Naoko Kamo
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Yosuke Miyachi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sena Iwamura
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Siyuan Yao
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisaya Shirai
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Yagi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
48
|
Latorre Fragua RA, Manuel Vázquez A, Ramiro Pérez C, de la Plaza Llamas R, Ramia Ángel JM. Influence of sarcopenia in major pancreatic surgery. A systematic review of the literature. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:142-154. [PMID: 32089375 DOI: 10.1016/j.gastrohep.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/20/2019] [Accepted: 01/10/2020] [Indexed: 02/06/2023]
Abstract
Post-operative morbidity of pancreatectomies occurs in up to 40-50% of patients, even in modern series. There is a need to find a simple scale in order to identify patients with increased risk of developing major post-operative complications after pancreatic resections. Many studies have been published on sarcopenia and surgical outcomes. Aspects of sarcopenia are presented, along with a systematic review using PRISMA guidelines, in order to search for articles about sarcopenia and pancreatic surgery. The impact of sarcopenia on morbidity and mortality in pancreatic resections is still unclear. The studies presented have been carried out over long periods of time, and many of them compare patients with different diseases. There are also different definitions of sarcopenia, and this can influence the results, as some of the reviewed articles have already shown. It is necessary to unify criteria, both in the definition and in the cut-off values. Prospective studies and consensus on sarcopenia diagnosis should be achieved.
Collapse
Affiliation(s)
- Raquel Aranzazu Latorre Fragua
- General and Digestive Surgery, University Hospital of Guadalajara, Calle Donante de Sangre s/n, 19002 Guadalajara, Spain.
| | - Alba Manuel Vázquez
- General and Digestive Surgery, University Hospital of Guadalajara, Calle Donante de Sangre s/n, 19002 Guadalajara, Spain
| | - Carmen Ramiro Pérez
- General and Digestive Surgery, University Hospital of Guadalajara, Calle Donante de Sangre s/n, 19002 Guadalajara, Spain
| | - Roberto de la Plaza Llamas
- General and Digestive Surgery, University Hospital of Guadalajara, Calle Donante de Sangre s/n, 19002 Guadalajara, Spain
| | - José Manuel Ramia Ángel
- General and Digestive Surgery, University Hospital of Guadalajara, Calle Donante de Sangre s/n, 19002 Guadalajara, Spain
| |
Collapse
|
49
|
Persson J, Fagevik Olsén M, Iresjö B, Smedh U. Body composition, sarcopenia, and quality of life in patients with oesophageal cancer before resection surgery and at follow‐up: a cohort study. JCSM CLINICAL REPORTS 2020. [DOI: 10.1002/crt2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jan Persson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Monika Fagevik Olsén
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Britt‐Marie Iresjö
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Ulrika Smedh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| |
Collapse
|
50
|
Psoas muscle size as a magnetic resonance imaging biomarker of progression of pancreatitis. Eur Radiol 2020; 30:2902-2911. [DOI: 10.1007/s00330-019-06633-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/03/2019] [Accepted: 12/13/2019] [Indexed: 12/13/2022]
|