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Okazoe Y, Yanagimoto H, Tsugawa D, Akita M, Mizumoto T, Yoshida T, So S, Ishida J, Urade T, Nanno Y, Fukushima K, Gon H, Komatsu S, Asari S, Toyama H, Kido M, Fukumoto T. Using the comprehensive complication index to assess the impact of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition on postoperative complications after resection for biliary tract cancer. Surg Today 2025:10.1007/s00595-025-03051-9. [PMID: 40423807 DOI: 10.1007/s00595-025-03051-9] [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: 12/16/2024] [Accepted: 03/25/2025] [Indexed: 05/28/2025]
Abstract
PURPOSE The Global Leadership Initiative on Malnutrition (GLIM) criteria, proposed in 2018, provide universal diagnostic standards for malnutrition, a known risk factor for postoperative complications in patients with various cancers. However, its impact on surgery for biliary tract cancer (BTC) remains unclear. This study evaluates the relationship between GLIM-defined malnutrition and postoperative complications after resection for BTC. METHODS The subjects of this retrospective study were patients who underwent pancreaticoduodenectomy or major hepatectomy with extrahepatic bile duct resection for BTC between January, 2013 and December, 2021. The comprehensive complication index (CCI), an indicator of postoperative complications, was calculated based on the total number and severity of postoperative complications. RESULTS GLIM-defined malnutrition was diagnosed in143 (71.1%) of the total 201 patients. The median CCI was significantly higher in the GLIM-defined malnutrition group than in the non-malnutrition group (37.2 vs. 28.3; P < 0.001). Multivariate logistic regression analysis revealed that GLIM-defined malnutrition (odds ratio 2.87 [95% confidence interval 1.38-5.96], P = 0.005) and intraoperative blood loss > 1,000 mL (odds ratio 3.77 [95% confidence interval 1.06-13.47], P = 0.041) were independent predictors of high morbidity (CCI ≥ 37.1). CONCLUSION Preoperative GLIM-defined malnutrition was closely associated with increased postoperative complications in patients who underwent resection for BTC.
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Affiliation(s)
- Yuki Okazoe
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Hiroaki Yanagimoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan.
| | - Daisuke Tsugawa
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Masayuki Akita
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Takuya Mizumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Toshihiko Yoshida
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Shinichi So
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Jun Ishida
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Takeshi Urade
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Yoshihide Nanno
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Kenji Fukushima
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Hidetoshi Gon
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Sadaki Asari
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
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Demirel AO, Topal U, Yavuz B, Kaycı Y, Atar C, Sarıtaş AG, Ülkü A, Pişkin FC, Akçam AT. Retrospective Analysis of the Effect of Sarcopenia on Mortality and Morbidity in Liver Transplant Patients. Transplant Proc 2025:S0041-1345(25)00221-0. [PMID: 40345940 DOI: 10.1016/j.transproceed.2025.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Accepted: 03/14/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND Sarcopenia significantly influences morbidity and mortality in liver transplant recipients. The psoas muscle area index and prognostic nutritional index (PNI) are potential indicators of sarcopenia's impact on postoperative outcomes. However, their association with postoperative morbidity and mortality in cadaveric liver transplant recipients remains underexplored. METHODS Data from 52 patients who underwent cadaveric liver transplantation at Çukurova University over 10 years were analyzed. Sarcopenia was assessed using psoas muscle area index (cutoffs, 4.62 mm²/cm² for males and 2.66 mm²/cm² for females, based on Bahat et al) and PNI (cutoffs, ≤45 for low and >45 for high, based on Li et al). Postoperative morbidity was evaluated using the Clavien-Dindo classification. The main outcomes were overall survival and morbidity rates. RESULTS Sarcopenic patients had shorter survival (62.2 ± 16.4 months) compared with nonsarcopenic patients (83.6 ± 11.4 months), although this difference was not statistically significant (P = .370). Sarcopenia was more common in males, Child-Pugh C patients, those with ascites, American Society of Anesthesiologists score of ≥3, and a Clavien-Dindo grade of ≥3 patients. It was significantly associated with low body mass index and albumin levels (P < .05) and was more prevalent in the low PNI group. A significant correlation was observed between PNI and Child-Pugh score (P = .012), alpha fetoprotein, and albumin levels (P = .007 and P = .001). CONCLUSION Sarcopenia negatively impacts survival, whereas a higher PNI correlates with a lower mortality risk. Further multicenter prospective studies with a larger population are needed to validate these findings.
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Affiliation(s)
- Ahmet Onur Demirel
- Department of General Surgery, Cukurova University Faculty of Medicine, Adana, Turkey.
| | - Uğur Topal
- Department of General Surgery Organ Transplantation, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Burak Yavuz
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Yunus Kaycı
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Cihan Atar
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Gökhan Sarıtaş
- Department of General Surgery Organ Transplantation, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Abdullah Ülkü
- Department of General Surgery Organ Transplantation, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ferhat Can Pişkin
- Department of Radiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Atılgan Tolga Akçam
- Department of General Surgery Organ Transplantation, Çukurova University Faculty of Medicine, Adana, Turkey
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Sever N, Yunusov E, Çağlar Eİ, Çelebi A, Majidova N, Kocaaslan E, Erel P, Ağyol Y, Güren AK, Paçacı B, Tunç MA, Işık S, Arıkan R, Bayoğlu İV, Sarı M, Cimşit C, Köstek O. Impact of Sarcopenia and Osteopenia on Prognosis in Metastatic Biliary Tract Cancer: A Single Center Experience. Nutr Cancer 2025; 77:610-618. [PMID: 40327413 DOI: 10.1080/01635581.2025.2496371] [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: 10/15/2024] [Revised: 04/14/2025] [Accepted: 04/15/2025] [Indexed: 05/08/2025]
Abstract
Sarcopenia, defined as skeletal muscle loss, has been known as a poor prognosis factor in various malignant diseases. We aimed to investigate the effect of sarcopenia on prognosis in patients with metastatic biliary tract cancer (mBTC) who received chemotherapy. We retrospectively collected clinic data of 70 patients with mBTC. Computed tomography scans were used to determine the skeletal muscle index at the third lumbar vertebra level for sarcopenia. Osteopenia was defined by averaging the radiodensity of consecutive five lumbar vertebrae in non-contrast CT scan images. Overall survival (OS) and progression free survival (PFS) were analyzed according to sarcopenia and osteopenia. Sarcopenia was present in 39 (55.7%) patients. Osteopenia was present 36 (51.4%) patients. Median PFS was 3.4 (2.7-4.1) and 6.5 (5.1-8.0) months in the sarcopenia and non- sarcopenia groups. Median OS was 4.1 (3.3-4.8) and 13.2 (9.9-16.4) months in the sarcopenia and non- sarcopenia groups. On multivariate analysis, the presence of sarcopenia (HR: 3.22, p = 0.001) and male sex (HR: 1.91, p = 0.02) were an independent predictor of poor OS. Osteopenia was not significantly associated with PFS and OS. Sarcopenia was associated with poor survival for metastatic BTC. Our aim was to raise awareness by emphasizing modifiable factors.
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Affiliation(s)
- Nadiye Sever
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Emil Yunusov
- Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Elçin İrem Çağlar
- Department of Radiology, Marmara University Hospital, İstanbul, Turkey
| | - Abdussamet Çelebi
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Nargiz Majidova
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Erkam Kocaaslan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Pınar Erel
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Yeşim Ağyol
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Ali Kaan Güren
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Burak Paçacı
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Mustafa Alperen Tunç
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Selver Işık
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Rukiye Arıkan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - İbrahim Vedat Bayoğlu
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Murat Sarı
- Departmant of Medical Oncology, İstanbul Medipol University, Beykoz, Turkey
| | - Canan Cimşit
- Department of Radiology, Marmara University Hospital, İstanbul, Turkey
| | - Osman Köstek
- Departmant of Medical Oncology, İstanbul Medipol University, Beykoz, Turkey
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Zhao Y, Becce F, Balmer R, do Amaral RH, Alemán-Gómez Y, Uldry E, Fraga M, Tsoumakidou G, Villard N, Denys A, Digklia A, Schaefer N, Duran R. Prognostic value of CT-based skeletal muscle and adipose tissue mass and quality parameters in patients with liver metastases and intrahepatic cholangiocarcinoma undergoing Yttrium-90 radioembolization. Eur Radiol 2025; 35:1415-1427. [PMID: 39838088 PMCID: PMC11835987 DOI: 10.1007/s00330-025-11349-y] [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] [Received: 08/07/2024] [Revised: 11/05/2024] [Accepted: 12/11/2024] [Indexed: 01/23/2025]
Abstract
OBJECTIVES To investigate baseline patient characteristics associated with the risk of computed tomography (CT)-based sarcopenia and assess whether sarcopenia and other morphometric parameters influence survival outcomes in patients with liver metastases and cholangiocarcinoma after Yttrium-90 radioembolization. MATERIALS AND METHODS We retrospectively analyzed 120 cancer patients (mean age, 62 ± 13.3 years, 61 men) who underwent preprocedural CT. Skeletal muscle index (SMI) was measured at the L3 vertebral level to identify sarcopenia. The Cox proportional hazard model was performed to assess the prognostic value of the variables, and Kaplan-Meier analysis with log-rank text was used for overall survival (OS) assessment. RESULTS Sarcopenia was diagnosed in 70 patients (58.3%). The multivariate regression analysis demonstrated that male sex, body mass index (BMI), visceral fat radiation attenuation (VFRA), skeletal muscle radiation attenuation (SMRA), and subcutaneous fat radiation attenuation (SFRA) were associated with the incidence of sarcopenia with the odds ratio of 8.81 (95% CI, 2.09-37.1, p = 0.003), 0.64 (95% CI, 0.48-0.85, p = 0.002), 1.23 (95% CI, 1.06-1.42, p = 0.006), 0.79 (95% CI, 0.69-0.91, p = 0.001) and 0.84 (95% CI, 0.76-0.93, p = 0.001), respectively. Age, skeletal muscle index, and tumor subtypes were independent prognostic factors for OS with the hazard ratio of 1.03 (95% CI, 1.01-1.05, p = 0.01), 0.92 (95% CI, 0.86-0.99, p = 0.021) and 2.09 (95% CI, 1.31-3.33 p = 0.002), respectively. In patients with intrahepatic cholangiocarcinoma, median OS was significantly longer in the non-sarcopenic group than in the sarcopenic patient (25.9 versus 6.5 months, p = 0.029). CONCLUSION Male sex, BMI, VFRA, SMRA, and SFRA were associated with the incidence of sarcopenia. SMI value could be used as a biomarker for OS in patients treated with Yttrium-90 radioembolization. KEY POINTS Question The prognostic significance of CT-based sarcopenia and other morphometric parameters in patients with liver metastases and cholangiocarcinoma undergoing Yttrium-90 radioembolization remains unclear. Findings A high skeletal muscle index has been identified as an independent protective factor for overall survival in cancer patients treated with Yttrium-90 radioembolization. Clinical relevance The negative impact of CT-based sarcopenia has been confirmed in the context of Yttrium-90 radioembolization. Clinicians should strive to prevent the progression of sarcopenia or maintain skeletal muscle index in perioperative management.
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Affiliation(s)
- Yan Zhao
- Department of Liver Diseases and Interventional Radiology, Digestive Diseases Hospital, Xi'an International Medical Center Hospital, Northwest University, Xi'an, China
| | - Fabio Becce
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Romain Balmer
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Ricardo H do Amaral
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Yasser Alemán-Gómez
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
- Connectomics Lab, Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Montserrat Fraga
- Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Nicolas Villard
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Medical Oncology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
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Lanari J, Lupi A, Billato I, Alessandris R, Crimì F, Caregari S, Pepe A, D'Amico FE, Vitale A, Quaia E, Cillo U, Gringeri E. Textbook outcome and nomogram-guided approaches for enhancing surgical success in elderly HCC patients: Deciphering the influence of sarcopenia. Updates Surg 2024; 76:2645-2654. [PMID: 39373845 PMCID: PMC11602817 DOI: 10.1007/s13304-024-01992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 09/05/2024] [Indexed: 10/08/2024]
Abstract
Sarcopenia, serving as a surrogate for frailty, is clinically significant in liver resection (LR) for elderly hepatocellular carcinoma (HCC) patients. Our study aims to assess sarcopenia's impact, measured by Psoas Muscle Index (PMI), on postoperative outcomes. We retrospectively studied patients aged ≥ 60 years who underwent LR for HCC between 2014 and 2018. PMI, derived from preoperative CT scans, and Textbook Outcome (TO) for LR were assessed. A nomogram predicting overall survival (OS) was developed via multivariable analysis. Of the 149 eligible HCC patients, the median PMI was 7.225 cm2/m2 in males and 4.882 cm2/m2 in females, with 37 (24.8%) patients identified as sarcopenic. Mortality was significantly associated with sarcopenia (HR 2.15; p = 0.032), MELD ≥ 10 (HR 3.13; p = 0.001), > 3 HCC nodules (HR 4.97; p = 0.001), and Clavien-Dindo ≥ 3 complications (HR 3.38; p < 0.001). Sarcopenic patients had a 5-year OS of 38.8% compared to 61% for non-sarcopenic individuals (p = 0.085). Achieving TO correlated with higher OS (p = 0.01). In sarcopenic cases, the absence of postoperative complications emerged as a limiting factor. Sarcopenic patients failing to achieve TO had worse OS compared to non-sarcopenic and TO-achieving counterparts (5-year OS 18.5%; p = 0.00039). Sarcopenia emerges as a prognostic factor for LR outcomes in elderly HCC patients. Postoperative complications in sarcopenic patients may compromise oncological outcomes.
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Affiliation(s)
- Jacopo Lanari
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
- General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy.
| | - Amalia Lupi
- Institute of Radiology, Department of Medicine, Padua University Hospital, University of Padua, Padua, Italy
| | - Ilaria Billato
- Department of Biology, University of Padua, Padua, Italy
| | - Remo Alessandris
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
- General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Filippo Crimì
- Institute of Radiology, Department of Medicine, Padua University Hospital, University of Padua, Padua, Italy
| | - Silvia Caregari
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
- General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, Padua University Hospital, University of Padua, Padua, Italy
| | - Francesco Enrico D'Amico
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
- General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Alessandro Vitale
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
- General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine, Padua University Hospital, University of Padua, Padua, Italy
| | - Umberto Cillo
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
- General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Enrico Gringeri
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
- General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
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Kolck J, Hosse C, Beetz NL, Auer TA, Marth AA, Segger L, Krenzien F, Lurje G, Pelzer U, Geisel D, Schöning W, Fehrenbach U. Beyond body mass index: Body composition profiling for perioperative risk stratification in intrahepatic cholangiocarcinoma patients. Cancer Rep (Hoboken) 2024; 7:e2070. [PMID: 39324689 PMCID: PMC11425665 DOI: 10.1002/cnr2.2070] [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] [Received: 09/07/2023] [Revised: 02/25/2024] [Accepted: 03/30/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND AND AIMS Intrahepatic cholangiocarcinoma (iCC) is an aggressive tumor, usually detected at an advanced stage. Our aim was to investigate the potential of body composition analysis (BCA) derived from presurgical staging computed tomography (CT) in predicting perisurgical complications. METHODS In this retrospective cohort study, we enrolled 86 patients who underwent CT imaging prior to liver surgery. Cox and logistic regression were performed to assess risk factors for prolonged hospital and intensive care unit (ICU) stays, as well as the occurrence of various complications. BCA parameters served as covariates besides conventional risk factors. RESULTS Postoperative complications after resection of iCC significantly prolonged the overall length of hospitalization (p < .001). Presence of sarcopenia was associated with longer ICU stays. Complications were common, with 62.5% classified as Clavien-Dindo grade IIIa or lower and 37.5% as more severe. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were identified as risk factors for complications, including bile leakage (in 24 cases, p = .025), pleural effusions (in 26 cases, p = .025), and intra-abdominal abscess formation (in 24 cases, p = .043). SAT was associated with severe complications requiring interventional therapy, whereas VAT was correlated with abscess formation. Despite normal prevalence of obesity (22%), body mass index (BMI) did not have an impact on the development of perioperative complications. CONCLUSION BCA is a useful tool for preoperative risk stratification in patients with iCC and is superior to BMI assessment. Increased SAT and VAT were associated with the risk of perisurgical complications, prolonging hospitalization. Therefore, BCA derived from routine staging CT should be considered in the preoperative assessment of patients with iCC.
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Affiliation(s)
- Johannes Kolck
- Department of RadiologyCKV, Charité – Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health at Charité – Universitätsmedizin BerlinBerlinGermany
| | - Clarissa Hosse
- Department of RadiologyCKV, Charité – Universitätsmedizin BerlinBerlinGermany
| | - Nick Lasse Beetz
- Department of RadiologyCKV, Charité – Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health at Charité – Universitätsmedizin BerlinBerlinGermany
| | - Timo Alexander Auer
- Department of RadiologyCKV, Charité – Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health at Charité – Universitätsmedizin BerlinBerlinGermany
| | | | - Laura Segger
- Department of RadiologyCKV, Charité – Universitätsmedizin BerlinBerlinGermany
| | - Felix Krenzien
- Berlin Institute of Health at Charité – Universitätsmedizin BerlinBerlinGermany
- Department of Surgery CCM/CVKCharité – Universitätsmedizin BerlinBerlinGermany
| | - Georg Lurje
- Department of Surgery CCM/CVKCharité – Universitätsmedizin BerlinBerlinGermany
| | - Uwe Pelzer
- Department of Hematology, Oncology and Cancer ImmunologyCharité – Universitätsmedizin BerlinBerlinGermany
| | - Dominik Geisel
- Department of RadiologyCKV, Charité – Universitätsmedizin BerlinBerlinGermany
| | - Wenzel Schöning
- Department of Surgery CCM/CVKCharité – Universitätsmedizin BerlinBerlinGermany
| | - Uli Fehrenbach
- Department of RadiologyCKV, Charité – Universitätsmedizin BerlinBerlinGermany
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7
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Mizuno Y, Yokoyama Y, Nakajima H, Inoue T, Tanaka S, Nagaya M, Inokawa Y, Ando M, Nishida Y, Ebata T. The impact of goal-directed prehabilitation therapy on functional capacity in patients undergoing hepatobiliary and pancreatic surgery: A randomized clinical trial. Surgery 2024; 176:252-258. [PMID: 38755033 DOI: 10.1016/j.surg.2024.04.024] [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: 10/31/2023] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Emerging evidence has supported the idea that goal-directed prehabilitation is a promising approach to boost functional capacity in preoperative patients. However, its usefulness has not been tested in the hepatobiliary and pancreatic fields. The objective of this trial was to investigate the efficacy of goal-directed prehabilitation for improving functional capacity in patients who were planned to undergo major hepatobiliary and pancreatic operations. METHODS This assessor-blinded, parallel-arm, randomized clinical trial recruited patients who were scheduled for major hepatobiliary and pancreatic surgeries for malignancy. Patients were randomly allocated into the step goal-directed prehabilitation group as the test group and into the conventional prehabilitation group as the control group. Patients in the goal-directed prehabilitation group participated in a walking prehabilitation program with an intergrading goal of the step count. Patients in the conventional prehabilitation group received standard physical and nutritional prehabilitation. The primary outcome was change in the 6-minute walking distance, which ranged from the time before starting prehabilitation (baseline) to the time after completing prehabilitation (immediately before surgery). RESULTS Among 180 randomized patients, 144 patients were included in the primary analysis (73 patients in the conventional prehabilitation group and 71 patients in the goal-directed prehabilitation group). The mean change in the 6-minute walking distance was 27 meters in the conventional prehabilitation group and 31 meters in the goal-directed prehabilitation group (P = .633). CONCLUSION In patients undergoing major hepatobiliary and pancreatic surgeries for malignancies, a goal-directed prehabilitation program did not result in a significantly greater increase in functional capacity than did conventional prehabilitation. REGISTRATION NUMBER UMIN000038791 (https://www.umin.ac.jp/).
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Affiliation(s)
- Yota Mizuno
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Hiroki Nakajima
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Inoue
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Motoki Nagaya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshikuni Inokawa
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan; Department of Orthopedic 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
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8
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Qu G, Zhou C, Zhang Y, Lyu SC, Lang R. Influence of sarcopenia on postoperative complications and long-term survival in pancreatic cancer patients undergone pancreaticoduodenectomy. Front Nutr 2024; 11:1434630. [PMID: 39027658 PMCID: PMC11254807 DOI: 10.3389/fnut.2024.1434630] [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: 05/18/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Sarcopenia has the potential to impact the postoperative results and extended prognosis of various types of tumors. Nevertheless, the specific impact of sarcopenia on the postoperative results and long-term survival of pancreatic cancer (PC) following pancreaticoduodenectomy (PD) remains inadequately elucidated. This study investigates the significance of sarcopenia according to various Asian standards on postoperative complications and long-term prognosis in PC patients who have undergone PD. METHODS This retrospective study systematically analyzed patients with PC who underwent PD from January 2015 to December 2022. Sarcopenia was diagnosed by the skeletal muscle index (SMI) obtained by the skeletal muscle area normalized for height squared on the third lumbar vertebra on computed tomography (CT) images. Univariate and multivariate logistic regression analysis were performed to analyze the correlation between sarcopenia and postoperative complications, while Cox regression analysis was utilized to explore the influence of sarcopenia on overall survival (OS) and recurrence-free survival (RFS) in PC patients after PD. RESULTS We enrolled 162 patients with PC after PD (92 males and 70 females, mean age: 63.78 ± 10.27 years), including 83 and 79 patients with sarcopenia and non-sarcopenia, respectively. Compared with non-sarcopenia patients, sarcopenia exhibited higher rates of recurrence rate (75% versus 59%, p = 0.039). Univariate and multivariate logistic regression analysis showed that sarcopenia did not affect the incidence of complications in patients with PC after PD in three Asian sarcopenia criteria. Multivariate Cox regression analysis indicated that sarcopenia was an independent risk factor for OS (hazard ratio [HR]: 2.49, 95% confidence interval [CI]: 1.73-3.60, p < 0.001) and RFS(hazard ratio [HR]: 1.70, 95%confidence interval [CI]: 1.12-2.50, p = 0.012) of PC patients with PD in Japanese Society of Hepatology criteria. Meanwhile, according to the Asian pancreatic cancer population standard, sarcopenia is an independent risk factor affecting the long-term OS (hazard ratio [HR]: 2.59, 95% confidence interval [CI]: 1.80-3.70, p < 0.001) and RFS (hazard ratio [HR]: 2.00, 95% confidence interval [CI]: 1.36-3.00, p < 0.001) of PC after PD. While sarcopenia is recognized as a risk factor for OS (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.08-3.10, p = 0.025) in PC patients based on the Fujiwara criteria, it is not found to be associated with RFS (hazard ratio [HR]: 1.60, 95% confidence interval [CI]: 0.90-3.00, p = 0.10). The model based on sarcopenia and clinical characteristics has high predictive ability for OS and RFS. CONCLUSION Various Asian diagnostic criteria do not link sarcopenia with postoperative complications in PC patients after PD. Nevertheless, sarcopenia remains a significant independent risk factor for long-term survival, and its combination with clinical characteristics can aid clinicians in predicting long-term survival outcomes.
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Affiliation(s)
- Guangzhen Qu
- Department of Interventional Radiology, Beijing Chao-Yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Chuanguo Zhou
- Department of Interventional Radiology, Beijing Chao-Yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Yong Zhang
- Department of Interventional Radiology, Beijing Chao-Yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Shao-Cheng Lyu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing, China
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9
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Bozzetti F. Evolving concepts on perioperative nutrition of sarcopenic cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106748. [PMID: 36376142 DOI: 10.1016/j.ejso.2022.10.008] [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] [Received: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022]
Abstract
The recent recognition of the association of sarcopenia with an increased risk of complications after a surgical procedure calls for rethinking the proper approach of the perioperative care in cancer patients. Sarcopenia is broadly considered in literature according to three different definitions: loss of muscle mass, loss of muscle mass plus reduced muscle function and myosteatosis. The aim of this short review on this issue is to define the excess of risk by type of primary and of surgical procedure, depending on the definition of sarcopenia, to speculate on this association (casual versus causal) and to examine the current therapeutical approaches. The analysis of the data shows that sarcopenia, defined as loss of muscle mass plus reduced muscle function, has the higher predictive power for the occurrence of postoperative complications than the two other definitions, and any definition of sarcopenia works better than the usual indexes or scores of surgical risk. Our analysis supports the concept that: a) sarcopenia is frequently associated with inflammation, but inflammation cannot be considered the only or the absolute cause for sarcopenia, b) sarcopenia is not a simple marker of risk but can have a direct role in the increase of risk. Data on perioperative care of sarcopenic cancer patients are scanty but a correct approach cannot rely on nutritional support alone but on a combined approach of optimized nutrition and exercise, hopefully associated with an anti-inflammatory treatment. This strategy should be applied proactively in keeping with the recent recommendations of the American Society of Clinical Oncology for the medical treatment of advanced cancer patients even if a clear demonstration of effectiveness is still lacking.
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Affiliation(s)
- Federico Bozzetti
- University of Milan, Faculty of Medicine, via Festa del Perdono, 20100, Milano, Italy.
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10
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Arntz PJW, Olthof PB, Korenblik R, Heil J, Kazemier G, van Delden OM, Bennink RJ, Damink SWMO, van Dam RM, Schadde E, Erdmann JI. Effect of Sarcopenia on the Increase in Liver Volume and Function After Portal Vein Embolization. Cardiovasc Intervent Radiol 2024; 47:642-649. [PMID: 38416177 DOI: 10.1007/s00270-024-03676-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Sarcopenia is associated with a decreased kinetic growth rate (KGR) of the future liver remnant (FLR) after portal vein embolization (PVE). However, little is known on the increase in FLR function (FLRF) after PVE. This study evaluated the effect of sarcopenia on the functional growth rate (FGR) after PVE measured with hepatobiliary scintigraphy (HBS). METHODS All patients who underwent PVE at the Amsterdam UMC between January 2005 and August 2017 were analyzed. Functional imaging by HBS was used to determine FGR. Liver volumetry was performed using multiphase contrast computed tomography (CT). Muscle area measurement to determine sarcopenia was taken at the third lumbar level (L3). RESULTS Out of the 95 included patients, 9 were excluded due to unavailable data. 70/86 (81%) patients were sarcopenic. In the multivariate logistic regression analysis, sarcopenia (p = 0.009) and FLR volume (FRLV) before PVE (p = 0.021) were the only factors correlated with KGR, while no correlation was found with FGR. 90-day mortality was similar across the sarcopenic and non-sarcopenic group (4/53 [8%] versus 1/11 [9%]; p = 1.000). The resection rates were also comparable (53/70 [75%] versus 11/16 [69%]; p = 0.542). CONCLUSION FGR after PVE as measured by HBS appears to be preserved in sarcopenic patients. This is in contrast to KGR after PVE as measured by liver volumetry which is decreased in sarcopenic patients. LEVEL OF EVIDENCE Level 3b, cohort and case control studies.
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Affiliation(s)
- Pieter J W Arntz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pim B Olthof
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Remon Korenblik
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jan Heil
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany
| | - Geert Kazemier
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roelof J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven W M Olde Damink
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ronald M van Dam
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Erik Schadde
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of Surgery, Rush University Chicago, Chicago, IL, USA
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
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11
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Fujii A, Suzuki T, Sakai K, Matsuura N, Sugahara K, Katakura A, Nomura T. Impact of skeletal muscle mass on postoperative complications in oral cancer surgery. Maxillofac Plast Reconstr Surg 2024; 46:12. [PMID: 38538802 PMCID: PMC10973294 DOI: 10.1186/s40902-024-00417-w] [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: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 01/03/2025] Open
Abstract
BACKGROUND Sarcopenia is characterized by a progressive and generalized loss of skeletal muscle mass and strength. The aim of this retrospective study was to investigate the impact of skeletal muscle mass on adverse events in free-flap reconstruction for defects after oral cancer resection. RESULTS Of 120 patients, recipient-site adverse events occurred in 56 patients (46.7%), and recipient-site surgical site infections occurred in 45 patients (37.5%). Skeletal muscle index was significantly associated with recipient-site adverse events in univariate analysis (P < 0.05). Lower body mass index and skeletal muscle index were significantly associated with recipient-site surgical site infection in univariate analysis (P < 0.05). In the multiple logistic regression model, a lower skeletal muscle index was a significant risk factor for recipient-site adverse events and surgical site infections (adverse events odds ratio; 3.17/P = 0.04; surgical site infection odds ratio; 3.76/P = 0.02). CONCLUSIONS The SMI at level Th12 was an independent factor for postoperative AEs, especially SSI, in OSCC patients with free-flap reconstruction.
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Affiliation(s)
- Arisa Fujii
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Tokyo, 101-0061, Japan
| | - Taiki Suzuki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, Chiba, 272-8513, Japan
| | - Katsuhiko Sakai
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba, 272-8513, Japan
| | - Nobuyuki Matsuura
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba, 272-8513, Japan
| | - Keisuke Sugahara
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Tokyo, 101-0061, Japan
| | - Akira Katakura
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Tokyo, 101-0061, Japan.
| | - Takeshi Nomura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, Chiba, 272-8513, Japan
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12
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He J, Huang Y, Huang N, Jiang J. Prevalence and predictive value of sarcopenia in surgically treated cholangiocarcinoma: a comprehensive review and meta-analysis. Front Oncol 2024; 14:1363843. [PMID: 38571501 PMCID: PMC10989063 DOI: 10.3389/fonc.2024.1363843] [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: 12/31/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
Background Sarcopenia, marked by a reduction in skeletal muscle mass and function, is a condition that can manifest in elderly patients with cancer and has been recognized as a possible adverse factor affecting the survival of individuals diagnosed with malignant tumors. This systematic review and meta-analysis aimed to examine the prevalence of sarcopenia in individuals with cholangiocarcinoma while concurrently investigating the potential correlations between the presence of sarcopenia and various critical factors, including survival outcomes and postoperative complications. Methods A comprehensive search was conducted across multiple databases, including EMBASE, PubMed, Web of Science, Cochrane Library, and CNKI, employing keywords such as sarcopenia, cholangiocarcinoma, and prognosis. This research explored the prognostic value of sarcopenia on the survival of cholangiocarcinoma. The findings of this meta-analysis were presented using forest plots and a summarized effects model. The Newcastle-Ottawa Scale (NOS) was employed to evaluate the quality of the studies included in the analysis. Results A total of 33 articles from five databases were in in the quantitative analysis. A comprehensive meta-analysis revealed that the overall prevalence of sarcopenia among individuals diagnosed with cholangiocarcinoma was43%. Moreover, the analysis revealed a significant and noteworthy correlation between sarcopenia and key clinical parameters such as overall survival (OS), Recurrence-Free Survival (RFS), and Disease-Free Survival (DFS) in patients with cholangiocarcinoma. Subgroup analysis revealed that, when categorized by various ethnicities, diagnostic techniques, and tumor locations, sarcopenia consistently retained its status as a negative predictive factor. Furthermore, sarcopenia has emerged as a risk factor for postoperative complications. All included studies had an NOS score greater than 5, indicating a high quality of evidence. Conclusion The results suggest that sarcopenia is significantly related to survival outcomes and postoperative complications in cholangiocarcinoma. Appropriate diagnosis and treatment of sarcopenia should be implemented to improve the prognosis of individuals with cholangiocarcinoma. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023479866, identifier CRD42023479866.
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yuanyuan Huang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Na Huang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Jiaqing Jiang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
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13
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Takaoka S, Hamada T, Takahara N, Saito K, Endo G, Hakuta R, Ishida K, Ishigaki K, Kanai S, Kurihara K, Oyama H, Saito T, Sato T, Suzuki T, Suzuki Y, Tange S, Tokito Y, Tateishi R, Nakai Y, Fujishiro M. Skeletal muscle status and survival among patients with advanced biliary tract cancer. Int J Clin Oncol 2024; 29:297-308. [PMID: 38319509 PMCID: PMC10884055 DOI: 10.1007/s10147-023-02466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Studies have demonstrated a prognostic role of sarcopenia (i.e., loss of skeletal muscle volume and functionality) in patients with various cancer types. In patients with biliary tract cancer, the quantity and quality of skeletal muscles and their serial changes have not been fully investigated in relation to survival outcomes. METHODS We identified 386 patients with unresectable or recurrent biliary tract cancer and calculated skeletal muscle index (SMI) and skeletal muscle density (SMD) to estimate muscular quantity and quality, respectively, based on computed tomography images. Using the Cox regression model with adjustment for potential confounders, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for progression-free survival (PFS) and overall survival (OS) according to skeletal muscle status and its serial change. RESULTS Compared to patients without sarcopenia, patients with sarcopenia were associated with shorter PFS (multivariable HR, 1.60; 95% CI, 1.15-2.22; P = 0.005), but not with OS (P = 0.027) at the adjusted α level of 0.013. SMD at baseline was associated with OS (multivariable HR comparing the extreme quartiles, 1.52; 95% CI, 1.07-2.14; Ptrend = 0.012), but not with PFS (Ptrend = 0.13). A reduction in SMI rather than that in SMD was associated with OS. Progressive disease was a risk factor for reductions in SMI and SMD. CONCLUSIONS Skeletal muscle quantity and quality and their serial changes were associated with survival outcomes in patients with advanced biliary tract cancer. Our data highlight the importance of designing nutritional and physical interventions for improvements in skeletal muscle status.
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Affiliation(s)
- Shinya Takaoka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kei Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Go Endo
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryunosuke Hakuta
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kota Ishida
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazunaga Ishigaki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Kanai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo City, Tokyo, 113-8655, Japan
| | - Kohei Kurihara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Oyama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsunori Suzuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukari Suzuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuichi Tange
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yurie Tokito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo City, Tokyo, 113-8655, Japan.
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Khosla D, Misra S, Chu PL, Guan P, Nada R, Gupta R, Kaewnarin K, Ko TK, Heng HL, Srinivasalu VK, Kapoor R, Singh D, Klanrit P, Sampattavanich S, Tan J, Kongpetch S, Jusakul A, Teh BT, Chan JY, Hong JH. Cholangiocarcinoma: Recent Advances in Molecular Pathobiology and Therapeutic Approaches. Cancers (Basel) 2024; 16:801. [PMID: 38398194 PMCID: PMC10887007 DOI: 10.3390/cancers16040801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Cholangiocarcinomas (CCA) pose a complex challenge in oncology due to diverse etiologies, necessitating tailored therapeutic approaches. This review discusses the risk factors, molecular pathology, and current therapeutic options for CCA and explores the emerging strategies encompassing targeted therapies, immunotherapy, novel compounds from natural sources, and modulation of gut microbiota. CCA are driven by an intricate landscape of genetic mutations, epigenetic dysregulation, and post-transcriptional modification, which differs based on geography (e.g., for liver fluke versus non-liver fluke-driven CCA) and exposure to environmental carcinogens (e.g., exposure to aristolochic acid). Liquid biopsy, including circulating cell-free DNA, is a potential diagnostic tool for CCA, which warrants further investigations. Currently, surgical resection is the primary curative treatment for CCA despite the technical challenges. Adjuvant chemotherapy, including cisplatin and gemcitabine, is standard for advanced, unresectable, or recurrent CCA. Second-line therapy options, such as FOLFOX (oxaliplatin and 5-FU), and the significance of radiation therapy in adjuvant, neoadjuvant, and palliative settings are also discussed. This review underscores the need for personalized therapies and demonstrates the shift towards precision medicine in CCA treatment. The development of targeted therapies, including FDA-approved drugs inhibiting FGFR2 gene fusions and IDH1 mutations, is of major research focus. Investigations into immune checkpoint inhibitors have also revealed potential clinical benefits, although improvements in survival remain elusive, especially across patient demographics. Novel compounds from natural sources exhibit anti-CCA activity, while microbiota dysbiosis emerges as a potential contributor to CCA progression, necessitating further exploration of their direct impact and mechanisms through in-depth research and clinical studies. In the future, extensive translational research efforts are imperative to bridge existing gaps and optimize therapeutic strategies to improve therapeutic outcomes for this complex malignancy.
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Affiliation(s)
- Divya Khosla
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shagun Misra
- Department of Radiotherapy and Oncology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Pek Lim Chu
- Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Peiyong Guan
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore 138672, Singapore
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rajesh Gupta
- Department of GI Surgery, HPB, and Liver Transplantation, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Khwanta Kaewnarin
- SingHealth Duke-NUS Institute of Biodiversity Medicine, Singapore 168583, Singapore
| | - Tun Kiat Ko
- Cancer Discovery Hub, National Cancer Center Singapore, Singapore 168583, Singapore
| | - Hong Lee Heng
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Center Singapore, Singapore 168583, Singapore
| | - Vijay Kumar Srinivasalu
- Department of Medical Oncology, Mazumdar Shaw Medical Center, NH Health City Campus, Bommasandra, Bangalore 560099, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Deepika Singh
- SingHealth Duke-NUS Institute of Biodiversity Medicine, Singapore 168583, Singapore
| | - Poramate Klanrit
- Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen 40002, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Somponnat Sampattavanich
- Siriraj Center of Research Excellence for Systems Pharmacology, Department of Pharmacology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 73170, Thailand
| | - Jing Tan
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Center Singapore, Singapore 168583, Singapore
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Sarinya Kongpetch
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand
- Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Apinya Jusakul
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen 40002, Thailand
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Bin Tean Teh
- Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore 169857, Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore 138672, Singapore
- Laboratory of Cancer Epigenome, Division of Medical Science, National Cancer Center Singapore, Singapore 168583, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore 138673, Singapore
| | - Jason Yongsheng Chan
- Cancer Discovery Hub, National Cancer Center Singapore, Singapore 168583, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Division of Medical Oncology, National Cancer Center, Singapore 168583, Singapore
| | - Jing Han Hong
- Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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15
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Esposto G, Borriello R, Galasso L, Termite F, Mignini I, Cerrito L, Ainora ME, Gasbarrini A, Zocco MA. Ultrasound Evaluation of Sarcopenia in Patients with Hepatocellular Carcinoma: A Faster and Easier Way to Detect Patients at Risk. Diagnostics (Basel) 2024; 14:371. [PMID: 38396410 PMCID: PMC10887735 DOI: 10.3390/diagnostics14040371] [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: 12/20/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The condition of sarcopenia, defined as a progressive loss of musculoskeletal mass and muscular strength, is very common in patients with hepatocellular carcinoma (HCC) and presents a remarkable association with its prognosis. Thus, the early identification of sarcopenic patients represents one of the potential new approaches in the global assessment of HCC, and there is increasing interest regarding the potential therapeutic implications of this condition. The gold standard for the quantification of muscle mass is magnetic resonance imaging (MRI) or computed tomography (CT), but these techniques are not always feasible because of the high-cost equipment needed. A new possibility in sarcopenia identification could be muscle ultrasound examination. The measurement of specific parameters such as the muscle thickness, muscular fascicles length or pennation angle has shown a good correlation with CT or MRI values and a good diagnostic accuracy in the detection of sarcopenia. Recently, these results were also confirmed specifically in patients with chronic liver disease. This review summarizes the role of imaging for the diagnosis of sarcopenia in patients with HCC, focusing on the advantages and disadvantages of the diagnostic techniques currently validated for this aim and the future perspectives for the identification of this condition.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maria Assunta Zocco
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (G.E.); (R.B.); (L.G.); (F.T.); (I.M.); (L.C.); (M.E.A.); (A.G.)
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16
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Knoedler S, Schliermann R, Knoedler L, Wu M, Hansen FJ, Matar DY, Obed D, Vervoort D, Haug V, Hundeshagen G, Paik A, Kauke-Navarro M, Kneser U, Pomahac B, Orgill DP, Panayi AC. Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis. Int J Surg 2023; 109:4238-4262. [PMID: 37696253 PMCID: PMC10720826 DOI: 10.1097/js9.0000000000000688] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/04/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, the authors aimed to synthesize the available literature and investigate the impact of sarcopenia on perioperative and postoperative outcomes across all surgical specialties. METHODS The authors systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Their primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at 1, 3, and 5 years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population and on those of higher quality or prospective study design. RESULTS A total of 294 studies comprising 97 643 patients, of which 33 070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes, including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P <0.00001). A significantly lower survival rate in patients with sarcopenia was noted at 1, 3, and 5 years (all P <0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P <0.00001), cardiovascular (both P <0.00001), and emergency ( P =0.03 and P =0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia ( P <0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients ( P =0.007). Sensitivity analysis based on higher quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P <0.00001). CONCLUSION Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical subspecialties.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Rainer Schliermann
- Faculty of Social and Health Care Sciences, University of Applied Sciences Regensburg, Regensburg
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Mengfan Wu
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Frederik J. Hansen
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen, Erlangen
| | - Dany Y. Matar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Angie Paik
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Dennis P. Orgill
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Adriana C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
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17
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Beumer BR, Takagi K, Buettner S, Umeda Y, Yagi T, Fujiwara T, van Vugt JL, IJzermans JN. Impact of sarcopenia on clinical outcomes for patients with resected hepatocellular carcinoma: a retrospective comparison of Eastern and Western cohorts. Int J Surg 2023; 109:2258-2266. [PMID: 37204461 PMCID: PMC10442104 DOI: 10.1097/js9.0000000000000458] [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: 01/17/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Patient fitness is important for guiding treatment. Muscle mass, as a reflection thereof, can be objectively measured. However, the role of East-West differences remains unclear. Therefore, we compared the impact of muscle mass on clinical outcomes after liver resection for hepatocellular carcinoma (HCC) in a Dutch [the Netherlands (NL)] and Japanese [Japan (JP)] setting and evaluated the predictive performance of different cutoff values for sarcopenia. METHOD In this multicenter retrospective cohort study, patients with HCC undergoing liver resection were included. The skeletal muscle mass index (SMI) was determined on computed tomography scans obtained within 3 months before surgery. The primary outcome measure was overall survival (OS). Secondary outcome measures were: 90-day mortality, severe complications, length of stay, and recurrence-free survival. The predictive performance of several sarcopenia cutoff values was studied using the concordance index (C-index) and area under the curve. Interaction terms were used to study the geographic effect modification of muscle mass. RESULTS Demographics differed between NL and JP. Gender, age, and body mass index were associated with SMI. Significant effect modification between NL and JP was found for BMI. The predictive performance of sarcopenia for both short-term and long-term outcomes was higher in JP compared to NL (maximum C-index: 0.58 vs. 0.55, respectively). However, differences between cutoff values were small. For the association between sarcopenia and OS, a strong association was found in JP [hazard ratio (HR) 2.00, 95% CI [1.230-3.08], P =0.002], where this was not found in NL (0.76 [0.42-1.36], P =0.351). The interaction term confirmed that this difference was significant (HR 0.37, 95% CI [0.19-0.73], P =0.005). CONCLUSIONS The impact of sarcopenia on survival differs between the East and West. Clinical trials and treatment guidelines using sarcopenia for risk stratification should be validated in race-dependent populations prior to clinical adoption.
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Affiliation(s)
- Berend R. Beumer
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Kosei Takagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan Okayama University Hospital, Okayama, Japan
| | - Stefan Buettner
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Yuzo Umeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan Okayama University Hospital, Okayama, Japan
| | - Takahito Yagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan Okayama University Hospital, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan Okayama University Hospital, Okayama, Japan
| | - Jeroen L.A. van Vugt
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jan N.M. IJzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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18
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Portale G, Spolverato YC, Bartolotta P, Gregori D, Mazzeo A, Rettore C, Cancian L, Fiscon V. Skeletal Muscle Mass and Surgical Morbidity After Laparoscopic Rectal Cancer Resection. J Laparoendosc Adv Surg Tech A 2023. [PMID: 37130330 DOI: 10.1089/lap.2023.0068] [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: 05/04/2023] Open
Abstract
Background: Sarcopenia is a useful tool in predicting short-term results in patients undergoing surgery for gastrointestinal cancer. However, there are few studies addressing this issue in colorectal cancer, and even less specifically focused on rectal cancer. We evaluated the prognostic relevance of preoperative skeletal mass index on postoperative morbidity in patients undergoing laparoscopic curative resection for rectal cancer. Methods: Skeletal mass index data and clinicopathological characteristics of rectal cancer patients in a 15-year period (June 2005-December 2020) were evaluated; patients with metastatic disease at surgery were excluded; postoperative complications within 30 days were evaluated using the Clavien-Dindo classification. Results: A total of 166 patients were included in the study. The overall prevalence of sarcopenia was 60%. BMI, Hb, or albumin were not associated with sarcopenia. Hospital stay was not correlated with sarcopenia. Postoperative complications occurred in 51 patients (31%); by the Clavien-Dindo classification 31 (61%) grade I, 10 (14.5%) grade II, and 10 (14.5%) grade III. Overall complications were not significantly different in sarcopenic and nonsarcopenic patients (P = .10). Considering only patients with complications, sarcopenia was found to be a predictor of more severe postoperative morbidity (odds ratio 12.7, P = .021). On multivariable analysis, sarcopenia was not associated with postoperative morbidity. Conclusions: Skeletal muscle status in rectal cancer patients undergoing curative resection was not associated with overall postoperative morbidity, although there was a correlation between sarcopenia and more severe complications. Further studies in a larger cohort of patients are needed before conclusions can be drawn on the relationship between muscular depletion and surgical outcomes in rectal cancer patients.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Italy
| | | | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Antonio Mazzeo
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Carlo Rettore
- Department of Radiology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Luca Cancian
- Department of Radiology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Italy
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19
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Nakajima H, Yamaguchi J, Takami H, Hayashi M, Kodera Y, Nishida Y, Watanabe N, Onoe S, Mizuno T, Yokoyama Y, Ebata T. Impact of skeletal muscle mass on the prognosis of patients undergoing neoadjuvant chemotherapy for resectable or borderline resectable pancreatic cancer. Int J Clin Oncol 2023; 28:688-697. [PMID: 36872415 DOI: 10.1007/s10147-023-02321-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy is a common therapeutic procedure for patients with pancreatic cancer. This study aimed to investigate the association between the total psoas area (TPA) and prognosis in patients undergoing neoadjuvant chemotherapy for resectable or borderline resectable pancreatic cancer. STUDY DESIGN This retrospective study included patients who underwent neoadjuvant chemotherapy for pancreatic cancer. TPA was measured at the level of the L3 vertebra using computed tomography. The patients were divided into low-TPA and normal-TPA groups. These dichotomizations were separately performed in patients with resectable and those with borderline resectable pancreatic cancer. RESULTS In total, 44 patients had resectable pancreatic cancer and 71 patients had borderline resectable pancreatic cancer. Overall survival among patients with resectable pancreatic cancer did not differ between the normal- and low-TPA groups (median, 19.8 vs. 21.8 months, p = 0.447), whereas among patients with borderline resectable pancreatic cancer, the low-TPA group had shorter overall survival than the normal-TPA group (median, 21.8 vs. 32.9 months, p = 0.006). Among patients with borderline resectable pancreatic cancer, the low-TPA group was predictive of poor overall survival (adjusted hazard ratio, 2.57, p = 0.037). CONCLUSION Low TPA is a risk factor of poor survival in patients undergoing neoadjuvant chemotherapy for borderline resectable pancreatic cancer. TPA evaluation could potentially suggest the treatment strategy in this disease.
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Affiliation(s)
- Hiroki Nakajima
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
| | - Hideki Takami
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Hospital, Nagoya, Japan
| | - Masamichi Hayashi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan.
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
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20
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Roxburgh BH, Cotter JD, Campbell HA, Reymann U, Wilson LC, Gwynne-Jones D, van Rij AM, Thomas KN. Physiological relationship between cardiorespiratory fitness and fitness for surgery: a narrative review. Br J Anaesth 2023; 130:122-132. [PMID: 36529576 DOI: 10.1016/j.bja.2022.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
Epidemiological evidence has highlighted a strong relationship between cardiorespiratory fitness and surgical outcomes; specifically, fitter patients possess heightened resilience to withstand the surgical stress response. This narrative review draws on exercise and surgical physiology research to discuss and hypothesise the potential mechanisms by which higher fitness affords perioperative benefit. A higher fitness, as indicated by higher peak rate of oxygen consumption and ability to sustain metabolic homeostasis (i.e. higher anaerobic threshold) is beneficial postoperatively when metabolic demands are increased. However, the associated adaptations with higher fitness, and the related participation in regular exercise or physical activity, might also underpin the observed perioperative benefit through a process of hormesis, a protective adaptive response to the moderate and intermittent stress of exercise. Potential mediators discussed include greater antioxidant capacity, metabolic flexibility, glycaemic control, lean body mass, and improved mood.
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Affiliation(s)
- Brendon H Roxburgh
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; School of Physical Education, Sport and Exercise Sciences, Dunedin, University of Otago, New Zealand.
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, Dunedin, University of Otago, New Zealand
| | - Holly A Campbell
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ulla Reymann
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Luke C Wilson
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Department of Orthopaedic Surgery, Southern District Health Board, Dunedin, New Zealand
| | - Andre M van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kate N Thomas
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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21
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Asai Y, Yamaguchi J, Mizuno T, Onoe S, Watanabe N, Igami T, Uehara K, Yokoyama Y, Ebata T. Impact of preoperative muscle mass and quality on surgical outcomes in patients undergoing major hepatectomy for perihilar cholangiocarcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:202-211. [PMID: 35861026 DOI: 10.1002/jhbp.1220] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
PURPOSES This study sought to define the impact of skeletal muscle mass and quality on postoperative outcomes in patients with perihilar cholangiocarcinoma. METHODS Patients who underwent major hepatectomy for perihilar cholangiocarcinoma were included. The normalized total psoas area (TPA) (psoas muscle index [PMI]) and average Hounsfield units of the TPA (psoas muscle density [PMD]) were measured using preoperative computed tomography images. The cohort was dichotomized using the following indices: sex-specific lowest tertile (low PMI and low PMD) and other (normal PMI and normal PMD). Intraoperative and postoperative outcomes were compared, focusing on PMI and PMD. RESULTS A total of 456 patients were analyzed. The intraoperative blood loss (IBL) was 21.3 ml/kg in the low PMI group and 17.2 ml/kg in the normal PMI group (P = .008). Patients in the low PMI or PMD group experienced postoperative infectious complications more frequently than those in the other groups. The median survival time was 37.8 months in the low PMI group and 54.2 months in the normal PMI group (P = .027). CONCLUSIONS PMI and PMD were closely associated with IBL and postoperative infectious complications. Additionally, PMI impacted long-term survival. These results suggest an importance of improving muscle mass and quality before surgery.
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Affiliation(s)
- Yuichi Asai
- 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
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Onoe
- 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
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kay Uehara
- 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
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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22
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Ding C, Jia J, Han L, Zhou W, Liu Z, Bai G, Wang Q. Developing and validating a nomogram based on skeletal muscle index and clinical scoring system for prediction of liver failure after hepatectomy. Front Oncol 2023; 13:1036921. [PMID: 36741004 PMCID: PMC9893412 DOI: 10.3389/fonc.2023.1036921] [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: 09/05/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023] Open
Abstract
Background and objectives Hepatectomy is the preferred treatment for patients with liver tumors. Post-hepatectomy liver failure (PHLF) remains one of the most fatal postoperative complications. We aim to explore the risk factors of PHLF and create a nomogram for early prediction of PHLF. Methods We retrospectively analyzed patients undergoing hepatectomy at the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University between 2015 and 2022, and the patients were divided into training and internal validation cohorts at an 8:2 ratio randomly. The patients undergoing liver resection from the Affiliated Huaian Hospital of Xuzhou Medical University worked as external validation. Then, a nomogram was developed which was based on multivariate analyses to calculate the risk of PHLF. The area under the ROC curve (AUROC) and Hosmer -Lemeshow test was used to evaluate the prediction effect of the model. Results A total of 421 eligible patients were included in our study. Four preoperative variables were identified after multivariate analysis as follows, ASA (American Society of Anesthesiologists) score, Child-Pugh score, SMI (Skeletal muscle index), and MELD (Model for end-stage liver disease) score as independent predictors of PHLF. The area under the ROC curve of the predictive model in the training, internal, and external validation cohorts were 0.89, 0.82, and 0.89. Hosmer -Lemeshow P values in the training, internal, and external validation cohorts were 0.91, 0.22, and 0.15. The Calibration curve confirmed that our nomogram prediction results were in accurate agreement with the actual occurrence of PHLF. Conclusion We construct a nomogram to predict the grade B/C PHLF of ISGLS (International Study Group of Liver Surgery) in patients who underwent hepatic resection based on risk factors. This tool can provide a visual and accurate preoperative prediction of the grade B/C PHLF and guide the next step of clinical decision-making.
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Affiliation(s)
- Cong Ding
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Jianye Jia
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Lei Han
- Department of Radiology, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Wei Zhou
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Ziyan Liu
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Genji Bai
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China,*Correspondence: Genji Bai,
| | - Qian Wang
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
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23
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Wu DH, Liao CY, Wang DF, Huang L, Li G, Chen JZ, Wang L, Lin TS, Lai JL, Zhou SQ, Qiu FN, Zhang ZB, Chen YL, Wang YD, Zheng XC, Tian YF, Chen S. Textbook outcomes of hepatocellular carcinoma patients with sarcopenia: A multicenter analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:802-810. [PMID: 36586787 DOI: 10.1016/j.ejso.2022.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of sarcopenia on textbook outcome (TO) after hepatectomy in hepatocellular carcinoma (HCC) patients remains unclear. This study aimed to investigate the association between sarcopenia and TO, to clarify its long and short-term prognostic value, and to develop a nomogram model based on sarcopenia and TO for survival prediction. METHODS Patients who underwent HCC resection between January 2012 and March 2017 in three large hospitals in Fujian were retrospectively recruited and divided into sarcopenia and non-sarcopenia groups based on skeletal muscle index (SMI) values. TO was defined as no 30-day morality, no 30-day readmission, negative margins, no prolonged hospital stay, and no major complications. Multivariate regression was used to screen for clinical factors associated with TO. Nomograms of overall survival (OS) and recurrence-free survival (RFS) after hepatectomy for HCC were developed. RESULTS A total of 1172 patients were included in the study. The TO rates were 28.74% (121/421 patients) in the sarcopenia group and 43.4% (326/751 patients) in the non-sarcopenia group. The results showed that sarcopenia was an independent predictor of TO (p < 0.001), TO was an independent predictor of perioperative treatment-related sarcopenia (PTRS)(p = 0.002), and TO was an independent predictor of OS and RFS (p < 0.001). Nomogram models based on sarcopenia and TO were generated and accurately predicted OS and RFS at 1, 3, and 5 years. CONCLUSION Both sarcopenia and TO are independent predictors of OS and RFS after HCC resection. Sarcopenia was an independent predictor of TO. Sarcopenia influenced long-term survival by affecting short-term postoperative outcomes.
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Affiliation(s)
- Di-Hang Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Cheng-Yu Liao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Dan-Feng Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Long Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Ge Li
- Fujian Medical University Union Hospital, Fuzhou, China
| | | | - Liang Wang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Tian-Sheng Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Jian-Lin Lai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Song-Qiang Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Fu-Nan Qiu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Zhi-Bo Zhang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yan-Ling Chen
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Yao-Dong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Xiao-Chun Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Yi-Feng Tian
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China.
| | - Shi Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China.
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Bernardi L, Roesel R, Vagelli F, Majno-Hurst P, Cristaudi A. Imaging based body composition profiling and outcomes after oncologic liver surgery. Front Oncol 2022; 12:1007771. [PMID: 36568174 PMCID: PMC9773835 DOI: 10.3389/fonc.2022.1007771] [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: 07/30/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
Body composition profiling is gaining attention as a pre-operative factor that can play a role in predicting the short- and long- term outcomes of patients undergoing oncologic liver surgery. Existing evidence is mostly limited to retrospective and single-institution series and in many of these studies, the evaluation of body composition is based on parameters which are derived from CT-scan imaging. Among body composition phenotypes, sarcopenia is the most well studied but this is only one of the possible profiles which can impact the outcomes of oncologic hepatic surgery. Interest has recently grown in studying the effect of sarcopenic obesity, central obesity, or visceral fat amount, myosteatosis, and bone mineral density on -such patients. The objective of this review is to summarize the current evidence on whether imaging-based parameters of body composition have an impact on the outcome of patients undergoing liver surgery for each of the most frequent indications for liver resection in clinical practice: hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), and colorectal liver metastases (CRLM).
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Affiliation(s)
- Lorenzo Bernardi
- Department of Visceral Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Raffaello Roesel
- Department of Visceral Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | | | - Pietro Majno-Hurst
- Department of Visceral Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland,University of Southern Switzerland (USI), Department of Biomedical Science, Lugano, Switzerland
| | - Alessandra Cristaudi
- Department of Visceral Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland,University of Southern Switzerland (USI), Department of Biomedical Science, Lugano, Switzerland,*Correspondence: Alessandra Cristaudi,
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Nishimura K, Miyata K, Fukaya M, Yokoyama Y, Uehara K, Yamaguchi J, Mizuno T, Onoe S, Ogura A, Ebata T. Early volume loss of skeletal muscle after esophagectomy: a risk for late-onset postoperative pneumonia. Dis Esophagus 2022; 35:6565997. [PMID: 35397168 DOI: 10.1093/dote/doac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/14/2022] [Indexed: 12/24/2022]
Abstract
Late-onset postoperative pneumonia (LOPP) after esophagectomy is poorly understood. This study was designed to clarify the features and risk factors for this event. Patients who underwent esophagectomy for esophageal cancer between 2006 and 2016 were included. LOPP was defined as radiologically proven pneumonia that occurred over 3 months after surgery, and clinically relevant late-onset postoperative pneumonia (CR-LOPP) was defined as LOPP that required administration of oxygen and antibiotics in the hospital and/or more intensive treatment. The total psoas muscle area (TPA) was measured using preoperative and postoperative (at 3 months after surgery) computed tomography scan images. Potential risk factors for CR-LOPP were investigated. Among 175 study patients, 46 (26.3%) had LOPP, 29 (16.6%) of whom exhibited CR-LOPP with a cumulative incidence of 15.6% at 3 years and 22.4% at 5 years. Four (13.8%) of these patients died of LOPP. Univariable analysis showed that clinical stage ≥III (P = 0.005), preoperative prognostic nutritional index (PNI) <45 (P = 0.035), arrhythmia (P = 0.014), postoperative hospital stay ≥40 days (P = 0.003), and percent decrease of TPA more than 5% (P < 0.001) were associated with CR-LOPP but not early onset postoperative pneumonia. Multivariable analysis revealed that clinical stage ≥III (hazard ratio [HR] 3.01, P = 0.004), postoperative hospital stay ≥40 days (HR 2.51, P = 0.015), and percent decrease of TPA >5% (HR 9.93, P < 0.001) were independent risk factors for CR-LOPP. CR-LOPP occurred in over 20% of patients at 5 years, and early postoperative loss of TPA was a potential trigger for this delayed complication.
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Affiliation(s)
- Koudai Nishimura
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazushi Miyata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahide Fukaya
- 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
| | - Kay Uehara
- 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
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Ogura
- 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
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Low skeletal muscle mass in cholangiocarcinoma treated by surgical resection. A meta-analysis. HPB (Oxford) 2022; 24:997-1006. [PMID: 34906379 DOI: 10.1016/j.hpb.2021.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND To date, the role of low skeletal muscle mass (LSMM) in cholangiocarcinoma (CC) is unclear. Our purpose was to analyze the influence of LSMM on survival in patients with CC treated by surgical resection. METHODS MEDLINE, Cochrane, and SCOPUS databases were screened for associations between LSMM and survival in CC up to June 2021. Overall, 16 studies met the inclusion criteria. The methodological quality of the involved studies was analyzed using the QUADAS instrument. The meta-analysis was undertaken using RevMan 5.4 software. RESULTS The prevalence of LSMM was 48.40%. LSMM was associated with lower overall survival (OS): HR = 2.44, 95%CI = (2.01-2.96) (simple regression); HR = 2.39, 95%CI = (1.83-3.13) (multiple regression). In extrahepatic CC, sarcopenic patients had lower OS, simple regression: HR = 2.11, 95%CI = (1.39-3.20); multiple regression: HR = 2.28, 95%CI = (1.41-3.70). In intrahepatic CC, LSMM predicted recurrence free survival: HR = 2.33, 95%CI = (1.93-2.81) (simple regression); HR = 2.23, 95%CI = (1.73-2.88) (multiple regression). LSMM predicted OS in intrahepatic CC, simple regression: HR = 2.69, 95%CI = (2.24-3.24); multiple regression: HR = 2.43, 95%CI = (1.73-3.41). CONCLUSION LSMM is a risk factor for OS in patients with CC treated by surgical resection. LSMM is a predictor of RFS in patients with intrahepatic CC.
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Umezawa S, Kobayashi S, Otsubo T. Low preoperative psoas muscle mass index is a risk factor for distal cholangiocarcinoma recurrence after pancreatoduodenectomy: a retrospective analysis. World J Surg Oncol 2022; 20:176. [PMID: 35655260 PMCID: PMC9161607 DOI: 10.1186/s12957-022-02627-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/06/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study aimed to investigate whether preoperative muscle mass is associated with the recurrence of distal cholangiocarcinoma after pancreatoduodenectomy (PD). METHODS We retrospectively examined 88 patients who had undergone PD for distal cholangiocarcinoma. The preoperative psoas muscle mass index (PMI) was measured using computed tomography as an index of muscle mass. We performed multivariate analysis of factors influencing early recurrence and developed a prognostic survival model using independent risk factors for recurrence. RESULTS The cut-off PMI values for recurrence within 1 year of surgery, determined from the receiver operating characteristic curve, were 5.90 cm2/m2 in males and 3.98 cm2/m2 in females. Multivariate analysis of effects associated with early recurrence within 1 year indicated that low PMI (odds ratio [OR] 9.322; 95% confidence interval [CI] 2.832 - 30.678; p = 0.0002) and lymph node metastasis (OR 5.474; 95% CI 1.620 - 18.497; p = 0.0062) were independent risk factors, and the median recurrence-free survival (RFS) of the low and high PMI groups were 21.6 and 81.0 months, respectively (p = 0.0214). The median RFS for zero, one, and two risk factors of low PMI and lymph node metastasis were as follows: zero variables, median not reached; one variable, 15.3 months; two variables: 6 months. CONCLUSIONS Low preoperative PMI may be a risk factor for distal cholangiocarcinoma recurrence after PD. TRIAL REGISTRATION The Institutional Review Board of St. Marianna University School of Medicine approved this study prior to commencement of data collection and analysis on October 9, 2020 (IRB no. 5006) and waived the informed consent requirement.
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Affiliation(s)
- Saori Umezawa
- grid.412764.20000 0004 0372 3116Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511 Japan
| | - Shinjiro Kobayashi
- grid.412764.20000 0004 0372 3116Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511 Japan
| | - Takehito Otsubo
- grid.412764.20000 0004 0372 3116Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511 Japan
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Fujii W, Wada H, Hasegawa S, Mukai Y, Asukai K, Akita H, Sugase T, Yamamoto M, Takeoka T, Shinno N, Hara H, Kanemura T, Haraguchi N, Nishimura J, Yasui M, Matsuda C, Omori T, Miyata H, Ohue M, Sakon M, Takahashi H. Clinical impact of body composition on postoperative outcomes during neoadjuvant chemoradiation therapy for distal bile duct cancer. Mol Clin Oncol 2022; 16:109. [PMID: 35620208 PMCID: PMC9112400 DOI: 10.3892/mco.2022.2542] [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: 12/21/2021] [Accepted: 04/04/2022] [Indexed: 11/06/2022] Open
Abstract
Body composition changes during neoadjuvant therapy and their clinical significance have not been clarified. The present study aimed to investigate body composition changes during neoadjuvant chemoradiation therapy (NACRT) in patients with distal bile duct cancer and the clinical impact on postoperative complications and the prognosis. A total of 16 patients with distal bile duct cancer who underwent curative resection after NACRT were retrospectively evaluated. The area of skeletal muscle, visceral fat and subcutaneous fat on computed tomography and immunological and nutritional indices were assessed before and after NACRT. All 16 patients completed NACRT followed by pancreaticoduodenectomy without mortality. There was no significant change in the skeletal muscle mass index (SMI) during NACRT. Of the 16 patients, nine (56%) were defined as sarcopenic before NACRT, and eight (50%) met the criteria for sarcopenic after NACRT. The SMI and total fat area were significantly associated with postoperative pancreatic fistula (POPF) (P=0.019 and P=0.007, respectively). The patients with sarcopenia had a shorter disease-free survival time and overall survival time in comparison to patients without sarcopenia (P=0.025 and P=0.115, respectively). In conclusion, NACRT for distal bile duct cancer did not significantly affect the body composition, or the immunological or nutritional indices. Sarcopenia after NACRT was significantly associated with early recurrence in patients with distal bile duct cancer who received NACRT.
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Affiliation(s)
- Wataru Fujii
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Shinichiro Hasegawa
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Yosuke Mukai
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Kei Asukai
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Takahito Sugase
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Masaaki Yamamoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Tomohira Takeoka
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Naoki Shinno
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Hisashi Hara
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Takeshi Kanemura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Naotsugu Haraguchi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Chu Matsuda
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Takeshi Omori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Masato Sakon
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
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Shin SP, Koh DH. Clinical Impact of Sarcopenia on Cholangiocarcinoma. Life (Basel) 2022; 12:815. [PMID: 35743846 PMCID: PMC9224765 DOI: 10.3390/life12060815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Sarcopenia is considered an important factor affecting the prognosis of cancer patients. Only complete surgical resection confers the chance of curing cholangiocarcinoma with sarcopenia. However, the prognosis is poor, even for patients who undergo surgical resection. Data from 13 trials of patients with sarcopenia and intrahepatic cholangiocarcinoma (ICC) or perihilar cholangiocarcinoma (PHC) were collected and reviewed. During all trials, sarcopenia was assessed using the psoas muscle or total skeletal muscle at the L3 level on cross-sectional images. The data showed heterogeneity among the subjects and treatment options and discrepancies in methods of measuring muscle mass and setting the cut-off level. Despite conflicting results regarding morbidity, mortality, and recurrence, sarcopenia may be associated with poor overall survival and recurrence-free survival (RFS) for ICC patients. The impact of sarcopenia on the morbidity of ICC patients remains unclear. The impact of PHC on morbidity, mortality, and RFS is also unclear. Further well-designed studies are needed to elucidate the effects of sarcopenia on ICC and PHC.
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Affiliation(s)
- Suk-Pyo Shin
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77, Sakju-ro, Chuncheon-si 24253, Gangwon-do, Korea;
| | - Dong-Hee Koh
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea
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Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis. Cancers (Basel) 2022; 14:cancers14081935. [PMID: 35454842 PMCID: PMC9025609 DOI: 10.3390/cancers14081935] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Sarcopenia, which is defined as a loss of skeletal muscle mass, function and strength, is the result of major metabolic changes often observed in advanced liver disease. Its evaluation mirrors the nutritional and functional status of the patients, and thus has been recently implicated as an outcome predictor of patients with liver diseases and hepatocellular carcinoma. This study provides evidence that sarcopenia, as assessed by the skeletal muscle index, is associated with age and body mass index in liver surgery candidates. More importantly, it is associated with higher rates of major complications (Clavien-Dindo grade III or IV) in patients with compensated advanced chronic liver disease and/or portal hypertension undergoing liver resection for primary hepatocellular carcinoma. Abstract The burden of post-operative complications of patients undergoing liver resection for hepatocellular carcinoma (HCC) is a cause of morbidity and mortality. Recently, sarcopenia has been reported to influence the outcome of patients with cirrhosis. We aimed to assess factors associated with sarcopenia and its prognostic role in liver surgery candidates. We included all patients with compensated advanced chronic liver disease (cACLD) undergoing liver resection for primary HCC consecutively referred to the University of Bologna from 2014 to 2019 with an available preoperative abdominal CT-scan performed within the previous three months. A total of 159 patients were included. The median age was 68 years, and 80.5% of the patients were male. Sarcopenia was present in 82 patients (51.6%). Age and body mass index (BMI) were associated with the presence of sarcopenia at multivariate analysis. Thirteen (8.2%) patients developed major complications and 14 (8.9%) presented PHLF grade B-C. The model for end-stage liver disease score was associated with the development of major complications, whereas cACLD presence, thrombocytopenia, portal hypertension (PH), Child-Pugh score and Albumin-Bilirubin score were found to be predictors of clinically significative PHLF. The rate of major complications was 11.8% in sarcopenic patients with cACLD compared with no complications (0%) in patients without sarcopenia and cACLD (p = 0.032). The rate of major complications was significantly higher in patients with (16.3%) vs. patients without (0%) sarcopenia (p = 0.012) in patients with PH. In conclusion, sarcopenia, which is associated with age and BMI, may improve the risk stratification of post-hepatectomy major complications in patients with cACLD and PH.
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Lee O, Shin YC, Ryu Y, Shin SH, Heo JS, Lim CS, Han IW. Adverse Effects of Sarcopenic Obesity on Postoperative Complications after Major Hepatectomy in Patients with Hilar Cholangiocarcinoma. J Clin Med 2022; 11:jcm11071860. [PMID: 35407468 PMCID: PMC8999157 DOI: 10.3390/jcm11071860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
Sarcopenic obesity (SO), which is defined as a high ratio of visceral adipose tissue to skeletal muscle, is a well-known risk factor for post-hepatectomy outcomes in patients with hepatocellular carcinoma. However, few studies have evaluated the effect of SO on postoperative outcomes in patients with hilar cholangiocarcinoma (CCC). This retrospective study aimed to evaluate the effect of preoperative SO on postoperative outcomes in patients with hilar CCC following major hepatectomy. Preoperative SO was assessed in 328 patients undergoing hepatectomy for hilar CCC at three institutions between 2006 and 2016. SO was calculated from cross-sectional visceral fat and muscle area displayed on preoperative CT imaging. Preoperative SO was present in 98 patients (29.9%). The major complication rate in patients with SO was higher than in those without SO (54.1% vs. 37.0%, p = 0.004). Additionally, postoperative hospital stays were prolonged in patients with SO (18.5 vs. 16.5 days, p = 0.038). After multivariable analysis, SO was identified as an independent risk factor for major complications after hepatectomy in hilar CCC patients (OR = 0.866, 95% CI: 1.148–3.034, p = 0.012). Careful postoperative management is needed after major hepatectomy in hilar CCC patients with SO.
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Affiliation(s)
- Okjoo Lee
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
| | - Yong Chan Shin
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea;
| | - Youngju Ryu
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
| | - Sang Hyun Shin
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
| | - Jin Seok Heo
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
| | - Chang-Sup Lim
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 03088, Korea
- Correspondence: (C.-S.L.); (I.W.H.); Tel.: +82-2-870-3291 (C.-S.L.); +82-2-3410-0772 (I.W.H.); Fax: +82-2-831-2826 (C.-S.L.); +82-2-3410-6980 (I.W.H.)
| | - In Woong Han
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
- Correspondence: (C.-S.L.); (I.W.H.); Tel.: +82-2-870-3291 (C.-S.L.); +82-2-3410-0772 (I.W.H.); Fax: +82-2-831-2826 (C.-S.L.); +82-2-3410-6980 (I.W.H.)
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Xiao Y, Xiao-Yue Z, Yue W, Ruo-Tao L, Xiang-Jie L, Xing-Yuan W, Qian W, Xiao-Hua Q, Zhen-Yi J. Use of computed tomography for the diagnosis of surgical sarcopenia: Review of recent research advances. Nutr Clin Pract 2022; 37:583-593. [PMID: 35191086 DOI: 10.1002/ncp.10847] [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] [Received: 08/29/2021] [Revised: 12/14/2021] [Accepted: 01/22/2022] [Indexed: 11/12/2022] Open
Abstract
Sarcopenia, also known as muscle decay, is associated with high morbidity among surgical patients. It is highly correlated with adverse clinical outcomes, such as increased postoperative complications, prolonged hospital stay, and increased mortality. Computed tomography (CT) is one of the main methods for diagnosing sarcopenia, which has the advantages of intuitiveness, rapidity, and accuracy. Clinical studies have shown that CT-defined sarcopenia can help predict the clinical outcomes and prognosis of surgical patients and provide an important reference for the formulation of antitumor treatment protocols. In recent years, some scholars have tried to construct an intelligent CT-based diagnostic model, which is expected to improve the diagnostic efficiency and establish standardized diagnostic criteria for CT-defined sarcopenia. In this review, we summarize the recent progress in the understanding of the diagnosis of sarcopenia and its potential prognostic value in surgery.
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Affiliation(s)
- Yu Xiao
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhou Xiao-Yue
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu Yue
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Ruo-Tao
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | - Wang Qian
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Xiao-Hua
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jia Zhen-Yi
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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de Jong MC, Patel N, Hassan-Smith Z, Mihai R, Khan S. Sarcopenia is Associated with Reduced Survival following Surgery for Adrenocortical Carcinoma. Endocr Res 2022; 47:8-17. [PMID: 34340645 DOI: 10.1080/07435800.2021.1954942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM Adrenocortical cancer (ACC) is an aggressive malignancy and robust prognostic factors remain unclear. The presence of sarcopenia has been shown to negatively impact survival for other malignancies, but has not been extensively analyzed in ACC. METHODS Patients who underwent resection of their ACC between 2010 and 2020 were identified; therapeutic, operative, and outcome data were analyzed. Sarcopenia was assessed by calculation of the skeletal muscle index (SMI) and was defined as an SMI <52.4cm2/m2 for males and <38.5cm2/m2 for females. RESULTS Data on 35 patients (18 F: 17 M; median age 54 [range: 18-86]) who had primary surgical treatment were analyzed. Median tumor size was 10 cm [range:3-15]. In eleven patients (31%), the tumor was hormonally active (cortisol = 8;23%). Seventeen patients (49%) were classified as having sarcopenia on their pre-operative CT scan. The Intraclass Correlation Coefficient (ICC) for intra- and inter-observer variability showed very good agreement (0.99 and 0.98). There was no difference in incidence of sarcopenia stratifying for sex, BMI, or tumor-size, but incidence was higher with increasing age (p < .05). Overall median survival was 36 months, with 1- and 3-year survival rates of 77% and 52%. The presence of sarcopenia was strongly associated with a shorter overall survival (HR = 3.21; [95%CI: 1.06-9.69];p = .03) on unadjusted analyses. Moreover, age, higher T-stage, and presence of capsular invasion were also associated with poorer survival on univariable analyses. CONCLUSION The presence of sarcopenia in patients undergoing surgery for ACC could be a predictor of reduced overall survival, although replications of these analyses should be performed in similar, larger cohorts. Specifically, the influence of a patient's hormonal status on the manifestation of sarcopenia should be further defined.
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Affiliation(s)
- Mechteld C de Jong
- Department of Endocrine Surgery - Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neel Patel
- Department of Radiology - Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Zaki Hassan-Smith
- Centre for Endocrinology, Diabetes & Metabolism, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Radu Mihai
- Department of Endocrine Surgery - Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shahab Khan
- Department of Endocrine Surgery - Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Perisetti A, Goyal H, Yendala R, Chandan S, Tharian B, Thandassery RB. Sarcopenia in hepatocellular carcinoma: Current knowledge and future directions. World J Gastroenterol 2022; 28:432-448. [PMID: 35125828 PMCID: PMC8790553 DOI: 10.3748/wjg.v28.i4.432] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
Liver cancer is the second most occurring cancer worldwide and is one of the leading causes of cancer-related deaths. Hepatocellular carcinoma (HCC) is the most common (80%-90%) type among malignant liver cancers. Sarcopenia occurs very early in HCC and can predict and provide an opportunity to improve muscle health before engaging in the treatment options such as loco-regional, systemic, and transplant management. Multiple prognostic stating systems have been developed in HCC, such as Barcelona Clinic Liver Cancer, Child-Pugh score and Albumin-Bilirubin grade. However, the evaluation of patients' performance status is a major limitation of these scoring systems. In this review, we aim to summarize the current knowledge and recent advances about the role of sarcopenia in cirrhosis in general, while focusing specifically on HCC. Additionally, the role of sarcopenia in predicting clinical outcomes and prognostication in HCC patients undergoing loco-regional therapies, liver resection, liver transplantation and systematic therapy has been discussed. A literature review was performed using databases PubMed/MEDLINE, EMBASE, Cochrane, Web of Science, and CINAHL on April 1, 2021, to identify published reports on sarcopenia in HCC. Sarcopenia can independently predict HCC-related mortality especially in patients undergoing treatments such as loco-regional, surgical liver transplantation and systemic therapies. Basic research is focused on evaluating a balance of anabolic and catabolic pathways responsible for muscle health. Early clinical studies have shown promising results in methods to improve sarcopenia in HCC which can potentially increase prognosis in these patients. As sarcopenia occurs very early in HCC, it can predict and provide an opportunity to improve muscle health before engaging in the treatment options such as loco-regional, systemic, and transplant management. Further, sarcopenia measurement can obviate the confounding caused by the abdominal ascites in these patients. The use of sarcopenia can add to the existing scoring systems to better prognosticate the HCC.
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Affiliation(s)
- Abhilash Perisetti
- Department of Internal Medicine, Gastroenterology and Hepatology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
- Department of Interventional Oncology and Surgical Endoscopy, Parkview Health, Fort Wayne, IN 46825, United States
| | - Hemant Goyal
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, The Wright Center for Graduate Medical Education, Scranton, PA 18501, United States
| | - Rachana Yendala
- Department of Hematology and Oncology, Conway Regional Medical Center, Conway, AR 72034, United States
| | - Saurabh Chandan
- Department of Internal Medicine, Gastroenterology and Hepatology Division, CHI Creighton University Medical Center, Omaha, NE 68107, United States
| | - Benjamin Tharian
- Department of Internal Medicine, Gastroenterology and Hepatology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Ragesh Babu Thandassery
- Department of Medicine, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, United States
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Martin D, Maeder Y, Kobayashi K, Schneider M, Koerfer J, Melloul E, Halkic N, Hübner M, Demartines N, Becce F, Uldry E. Association between CT-Based Preoperative Sarcopenia and Outcomes in Patients That Underwent Liver Resections. Cancers (Basel) 2022; 14:cancers14010261. [PMID: 35008425 PMCID: PMC8750804 DOI: 10.3390/cancers14010261] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Cancer cachexia often includes sarcopenia, which is characterized by a progressive, generalized loss of skeletal muscle mass and strength, combined with fatty infiltration into the muscle. Sarcopenia has been considered a patient-specific imaging biomarker for predicting outcomes after cancer surgery. The present study aimed to evaluate whether preoperative sarcopenia was associated with postoperative outcomes and survival in patients that underwent liver resections. Sarcopenia, assessed by preoperative CT imaging, was present in two-thirds of patients. Independent risk factors for sarcopenia were age, male sex, ASA score ≥ 3, and malignancies. Based on CT assessment alone, sarcopenia had no impact on clinical outcomes or overall survival after hepatectomy. Abstract This retrospective observational study aimed to evaluate whether preoperative sarcopenia, assessed by CT imaging, was associated with postoperative clinical outcomes and overall survival in patients that underwent liver resections. Patients operated on between January 2014 and February 2020 were included. The skeletal muscle index (SMI) was measured at the level of the third lumbar vertebra on preoperative CT scans. Preoperative sarcopenia was defined based on pre-established SMI cut-off values. The outcomes were postoperative morbidity, length of hospital stay (LOS), and overall survival. Among 355 patients, 212 (59.7%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (63.5 years) and had significantly lower BMIs (23.9 kg/m2) than patients without sarcopenia (59.3 years, p < 0.01, and 27.7 kg/m2, p < 0.01, respectively). There was no difference in LOS (8 vs. 8 days, p = 0.75), and the major complication rates were comparable between the two groups (11.2% vs. 11.3%, p = 1.00). The median overall survival times were comparable between patients with sarcopenia and those without sarcopenia (15 vs. 16 months, p = 0.87). Based on CT assessment alone, preoperative sarcopenia appeared to have no impact on postoperative clinical outcomes or overall survival in patients that underwent liver resections. Future efforts should also consider muscle strength and physical performance, in addition to imaging, for preoperative risk stratification.
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Affiliation(s)
- David Martin
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (D.M.); (M.S.); (E.M.); (N.H.); (M.H.); (E.U.)
| | - Yaël Maeder
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (Y.M.); (J.K.); (F.B.)
| | - Kosuke Kobayashi
- Hepato-Pancreatico-Biliary Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo 113-8654, Japan;
| | - Michael Schneider
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (D.M.); (M.S.); (E.M.); (N.H.); (M.H.); (E.U.)
| | - Joachim Koerfer
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (Y.M.); (J.K.); (F.B.)
| | - Emmanuel Melloul
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (D.M.); (M.S.); (E.M.); (N.H.); (M.H.); (E.U.)
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (D.M.); (M.S.); (E.M.); (N.H.); (M.H.); (E.U.)
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (D.M.); (M.S.); (E.M.); (N.H.); (M.H.); (E.U.)
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (D.M.); (M.S.); (E.M.); (N.H.); (M.H.); (E.U.)
- Correspondence: ; Tel.: +41-21-314-24-00
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (Y.M.); (J.K.); (F.B.)
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland; (D.M.); (M.S.); (E.M.); (N.H.); (M.H.); (E.U.)
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Watanabe J, Matsui R, Sasanuma H, Ishizaki Y, Fukunaga T, Kotani K, Sata N. Body composition assessment and sarcopenia in patients with biliary tract cancer: A systematic review and meta-analysis. Clin Nutr 2021; 41:321-328. [PMID: 34999326 DOI: 10.1016/j.clnu.2021.12.005] [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] [Received: 08/03/2021] [Revised: 11/17/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sarcopenia, as assessed by body composition, can affect morbidity and survival in several gastrointestinal cancer. However, the impact of sarcopenia, referring to both quantity and quality of skeletal muscle, in biliary tract cancer (BTC) is debatable. We aimed to investigate the impact of sarcopenia on morbidity and mortality in patients with BTC. METHODS Electronic databases and trial registries were searched through July 2021 to perform random-effects meta-analyses. Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Twenty-nine studies (4443 patients) were included; 28 used computed tomography and one used dual-energy X-ray absorptiometry to assess body composition. Eighteen studies reported the impact of pre-operative sarcopenia on postoperative outcomes; namely, sarcopenia increased postoperative complications (risk ratio = 1.23, 95% confidence interval [CI] = 1.07 to 1.41; I2 = 2%), and decreased recurrence-free survival (hazard ratio [HR] = 2.20, 95% CI = 1.75 to 2.75; I2 = 0%) in multivariable analyses. Low muscle quantity (HR = 2.26, 95% CI = 1.75 to 2.92; I2 = 66%) and quality (HR = 1.75, 95% CI = 1.33 to 2.29; I2 = 50%) decreased overall survival in multivariable analyses. The certainty of the evidence was low because of heterogeneity and imprecision. CONCLUSIONS In sarcopenia, low muscle quantity and quality by body composition conferred an independent risk of morbidity and mortality in patients with BTC. Further studies are needed to confirm these findings and mitigate risk.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Ryota Matsui
- Department of Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Hideki Sasanuma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Yoichi Ishizaki
- Department of Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Tetsu Fukunaga
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, Japan.
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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The type of gastrectomy affects skeletal muscle loss and the long-term outcomes of elderly patients with gastric cancer: a retrospective study using computed tomography images. Surg Today 2021; 52:812-821. [PMID: 34837102 DOI: 10.1007/s00595-021-02414-2] [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: 06/14/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Sarcopenia is common in elderly gastrectomized patients and a known risk factor for postoperative complications and poor overall survival. However, the long-term outcomes of skeletal muscle loss after gastrectomy and the differences in outcomes of different gastrectomy procedures remain unclear. METHODS The subjects of this retrospective study were 136 patients who underwent various gastrectomy procedures for early gastric cancer, namely: total gastrectomy (TG; n = 20), proximal gastrectomy (PG; n = 16), distal gastrectomy (DG; n = 60), and pylorus-preserving gastrectomy (PPG; n = 40). Skeletal muscle volume (SMV), calculated as the skeletal muscle index (SMI), was measured using cross-sectional computed tomography (CT) scans preoperatively and then 1, 2, and 3 years after gastrectomy. RESULTS Sarcopenia developed from 2 years onwards in all the patients who underwent TG. The SMI and sarcopenia prevalence after gastrectomy deteriorated over time. Multivariate analysis revealed that TG and PG were significant risk factors for skeletal muscle loss in postoperative years 1 and 3. A decrease in the SMI after TG or PG was most remarkable in elderly patients. CONCLUSIONS The type of gastrectomy affects skeletal muscle loss in the long term. Elderly patients who undergo TG or PG are at high risk of severe skeletal muscle loss.
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Sarcopenia and Myosteatosis as Prognostic Markers in Patients with Advanced Cholangiocarcinoma Undergoing Palliative Treatment. J Clin Med 2021; 10:jcm10194340. [PMID: 34640358 PMCID: PMC8509694 DOI: 10.3390/jcm10194340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cholangiocarcinoma (CCA) represents the second most common primary liver cancer and is characterized by a very poor outcome, but reliable prognostic markers are largely missing. Sarcopenia, the progressive loss of muscle mass and strength, as well as myosteatosis have been associated with an unfavorable outcome in several clinical conditions, including cancer. Here, we evaluated the prognostic relevance of sarcopenia and myosteatosis using routine abdominal CT (computed tomography) scans in advanced stage CCA patients undergoing palliative treatment. METHODS Routine abdominal CT scans were used to assess the skeletal muscle and the psoas muscle index (L3SMI/L3PMI) at the level of the third lumbar vertebra as radiological indices for sarcopenia as well as the mean skeletal muscle attenuation (MMA) as a surrogate for myosteatosis. Results were correlated with clinical data and outcomes. RESULTS Using a calculated optimal cut-off value of 71.95 mm2/cm, CCA patients with an L3SMI value below this cut-off showed a significantly reduced median overall survival (OS) of only 250 days compared to 450 days in patients with a higher L3SMI. Moreover, the median OS of CCA patients with an L3PMI above 6345 mm2/cm was 552 days compared to 252 days in patients with a lower L3PMI. Finally, CCA patients with an MMA above 30.51 Hounsfield Units survived significantly longer (median OS: 430 days) compared to patients with an MMA value below this ideal cut-off (median OS: 215 days). The prognostic relevance of L3SMI, L3PMI, and MMA was confirmed in uni- and multivariate Cox regression analyses. CONCLUSION Routine abdominal CT scans represent a unique opportunity to evaluate sarcopenia as well as myosteatosis in advanced CCA patients. We identified the L3SMI/L3PMI as well as the MMA as negative prognostic factors in CCA patients undergoing palliative therapy, arguing that the "opportunistic" evaluation of these parameters might yield important clinical information in daily routine.
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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: 2.0] [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.
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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
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Williet N, Fovet M, Maoui K, Chevalier C, Maoui M, Le Roy B, Roblin X, Hag B, Phelip JM. A Low Total Psoas Muscle Area Index Is a Strong Prognostic Factor in Metastatic Pancreatic Cancer. Pancreas 2021; 50:579-586. [PMID: 33939672 DOI: 10.1097/mpa.0000000000001796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The total psoas area index (TPI) is an emerging alternative to the total skeletal muscle area index as a prognostic factor but has never been evaluated in metastatic pancreatic cancer (mPC). METHODS Areas were manually recorded, as previously described. Sex-specific cutoffs were identified by optimum stratification of TPI using log-rank χ2 statistic associated with mortality to define sarcopenic psoas. Progression-free survival (PFS) and overall survival (OS) were the primary objectives. Two period groups were used as internal validation. RESULTS During the period study, 79 patients were treated for mPC. The TPI was correlated with PFS (hazards ratio, 0.81; P = 0.02) and OS (hazards ratio, 0.7; P < 0.001). Optimum thresholds defining sarcopenic psoas were less than 5.73 cm2/m2 in men and less than 4.37 cm2/m2 in women. Patients with sarcopenic psoas (62.0%) had shorter median PFS (2.9 months) compared with the others (6.6 months, adjusted P log-rank = 0.01), independently to the intensity of chemotherapy, weight loss, and performance status greater than 1. Similarly, OS was independently shorter in patients with sarcopenic psoas (7.6 months) versus the others (22.2 months, adjusted P < 0.001). These results were confirmed in the 2 period groups. CONCLUSIONS A low TPI is a stronger independent prognostic factor in mPC.
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Affiliation(s)
| | - Marion Fovet
- From the Department of Hepatogastroenterology, University Hospital of Saint-Etienne, Saint-Etienne
| | - Khawla Maoui
- From the Department of Hepatogastroenterology, University Hospital of Saint-Etienne, Saint-Etienne
| | - Clément Chevalier
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez
| | - Meriem Maoui
- Department of Radiology, Hospice Civils de Lyon, Lyon
| | - Bertrand Le Roy
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Xavier Roblin
- From the Department of Hepatogastroenterology, University Hospital of Saint-Etienne, Saint-Etienne
| | - Bachir Hag
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez
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Wang H, Yang R, Xu J, Fang K, Abdelrahim M, Chang L. Sarcopenia as a predictor of postoperative risk of complications, mortality and length of stay following gastrointestinal oncological surgery. Ann R Coll Surg Engl 2021; 103:630-637. [PMID: 33739153 DOI: 10.1308/rcsann.2021.0082] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Sarcopenia has drawn considerable attention as a predictor of postoperative risk, although the relationship between sarcopenia and postoperative risk is contentious. This meta-analysis was conducted to evaluate this relationship. METHODS A systematic literature search up to May 2020 was carried out and 43 studies were identified (with 16,716 patients) reporting on the relationship between sarcopenia and postoperative risk. In order to evaluate this relationship, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the dichotomous and continuous method with a random or fixed effects model. RESULTS Compared with non-sarcopenic patients, those with sarcopenia have a higher major complications rate (OR: 4.03, 95% CI: 2.49-5.57, p<0.001), a higher total complications rate (OR: 1.77, 95% CI: 1.40-2.24, p<0.001), a higher 30-day mortality rate (OR: 2.38, 95% CI: 1.56-3.63, p<0.001) and a longer hospital stay (mean difference: 4.54 days, 95% CI: 2.49-6.59 days, p<0.001). CONCLUSIONS Sarcopenia significantly increases the risk of major complications, total complications, 30-day mortality and length of hospital stay. For this reason, it is recommended that sarcopenia is added to preoperative risk evaluation to avoid any possible negative outcomes following gastrointestinal oncological surgery.
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Affiliation(s)
- H Wang
- Yantaishan Hospital, Yantai, Shandong, China
| | - R Yang
- Qishan Hospital, Yantai, Shandong, China
| | - J Xu
- Qishan Hospital, Yantai, Shandong, China
| | - K Fang
- Wuhan Jin Yin Tan Hospital, Wuhan, Hubei, China
| | | | - L Chang
- Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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Nguyen LT, Dang AK, Duong PT, Phan HBT, Pham CTT, Nguyen ATL, Le HT. Nutrition intervention is beneficial to the quality of life of patients with gastrointestinal cancer undergoing chemotherapy in Vietnam. Cancer Med 2021; 10:1668-1680. [PMID: 33550719 PMCID: PMC7940238 DOI: 10.1002/cam4.3766] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The best treatment therapy for gastrointestinal cancer patients is assessed by the improvement of health status and quality of life (QoL) after treatments. Malnutrition is related to loss of muscle strengths which leads to lower physical performance and emotional status. Thus, this study aimed to estimate the effects of nutritional interventions on the improvement of QoL among gastrointestinal patients undergoing chemotherapy in Vietnam. METHODS A quasi-experiment with intervention and control groups for pre- and post-intervention assessment was carried out at the Department of Oncology and Palliative Care-Hanoi Medical University Hospital from 2016 to 2019. Sixty gastrointestinal cancer patients were recruited in each group. The intervention regimen consisted of nutritional counseling, a specific menu with a recommended amount of energy, protein, and formula milk used within 2 months. Nutritional status and QoL of patients were evaluated using The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and The European Organization for Research and Treatment of Cancer (EORTC). The difference in differences (DiD) method was utilized to estimate the outcome between control and intervention groups. RESULTS After the intervention, patients of the intervention group had better changes in scores of global health status (Coef =16.68; 95% CI =7.90; 25.46), physical (Coef =14.51; 95% CI =5.34; 23.70), and role functioning (Coef =14.67; 95% CI =1.63; 27.70) compared to the control group. Regarding symptom scales, the level of fatigue, pain, and insomnia symptoms significantly reduced between pre- and post-intervention in the intervention group. In addition, living in urban areas, defined as malnourished and having low prealbumin levels, were positively associated with the lower global health status/QoL score. CONCLUSION Nutritional therapy with high protein was beneficial to the improvement in QoL, physical function and the reduction of negative symptoms among gastrointestinal cancer patients. Early individualized nutritional support in consultation with professional dietitians during chemotherapy plays an integral part in enhancing the QoL and better treatment prognosis. CLINICAL TRIAL REGISTRATION NUMBER NCT04517708.
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Affiliation(s)
- Linh Thuy Nguyen
- Institute for Preventive Medicine and Public HealthHanoi Medical UniversityHanoiVietnam
- Department of Nutrition and DieteticHanoi Medical University HospitalHanoiVietnam
| | - Anh Kim Dang
- Institute for Preventive Medicine and Public HealthHanoi Medical UniversityHanoiVietnam
| | - Phuong Thi Duong
- Department of Nutrition and DieteticHanoi Medical University HospitalHanoiVietnam
| | - Hanh Bich Thi Phan
- Institute for Preventive Medicine and Public HealthHanoi Medical UniversityHanoiVietnam
| | - Chinh Tuyet Thi Pham
- Department of Nutrition and DieteticHanoi Medical University HospitalHanoiVietnam
| | - Anh Tuan Le Nguyen
- Institute for Preventive Medicine and Public HealthHanoi Medical UniversityHanoiVietnam
| | - Huong Thi Le
- Institute for Preventive Medicine and Public HealthHanoi Medical UniversityHanoiVietnam
- Department of Nutrition and DieteticHanoi Medical University HospitalHanoiVietnam
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Doolittle DA, Hernandez MC, Baffour FI, Moynagh MR, Takahashi N, Froemming AT, Glazebrook KN, Kim BD. CT-derived sarcopenia should not preclude surgical stabilization of traumatic rib fractures. Eur Radiol Exp 2021; 5:9. [PMID: 33590301 PMCID: PMC7884563 DOI: 10.1186/s41747-021-00206-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Rib fractures are associated with considerable morbidity and mortality. Surgical stabilization of rib fractures (SSRF) can be performed to mitigate complications. Sarcopenia is in general known to be associated with poor clinical outcomes. We investigated if sarcopenia impacted number of days of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay in patients who underwent SSRF. METHODS A retrospective single institutional review was performed including patients who underwent SSRF (2009-2017). Skeletal muscle index (SMI) was semiautomatically calculated at the L3 spinal level on computed tomography (CT) images and normalized by patient height. Sarcopenia was defined as SMI < 55 cm2/m2 in males and < 39 cm2/m2 in females. Demographics, operative details, and postoperative outcomes were reviewed. Univariate and multivariate analyses were performed. RESULTS Of 238 patients, 88 (36.9%) had sarcopenia. There was no significant difference in number of days of mechanical ventilation (2.8 ± 4.9 versus 3.1 ± 4.3, p = 0.304), ICU stay (5.9 ± 6.5 versus 4.9 ± 5.7 days, p = 0.146), or total hospital stay (13.3 ± 7.2 versus 12.9 ± 8.2 days, p = 0.183) between sarcopenic and nonsarcopenic patients. Sarcopenic patients demonstrated increased modified frailty index scores (1.5 ± 1.1 versus 0.9 ± 0.9, p < 0.001) compared to nonsarcopenic patients. CONCLUSIONS For patients who underwent SSRF for rib fractures, sarcopenia did not increase the number of days of mechanical ventilation, ICU stay, or total hospital stay. Sarcopenia should not preclude the utilization of SSRF in these patients.
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Affiliation(s)
- Derrick A Doolittle
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Matthew C Hernandez
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Francis I Baffour
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Adam T Froemming
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Katrina N Glazebrook
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Brian D Kim
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Roh YH, Kang BK, Song SY, Lee CM, Jung YK, Kim M. Preoperative CT anthropometric measurements and pancreatic pathology increase risk for postoperative pancreatic fistula in patients following pancreaticoduodenectomy. PLoS One 2020; 15:e0243515. [PMID: 33270774 PMCID: PMC7714124 DOI: 10.1371/journal.pone.0243515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/22/2020] [Indexed: 02/06/2023] Open
Abstract
Postoperative pancreatic fistula (POPF) is a common complication following pancreaticoduodenectomy (PD). However, risk factors for this complication remain controversial. We conducted a retrospective analysis of 107 patients who underwent PD. POPF was diagnosed in strict accordance with the definition of the 2016 update of pancreatic fistula from the International Study Group on Pancreatic Fistula (ISGPF). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POPF. A total of 19 (17.8%) subjects of pancreatic fistula occurred after PD, including 15 (14.1%) with grade B POPF and 4 (3.7%) with grade C POPF. There were 33 (30.8%) patients with biochemical leak. Risk factors for POPF (grade B and C) were larger area of visceral fat (odds ratio [OR], 1.40; p = 0.040) and pathology other than pancreatic adenocarcinoma or pancreatitis (OR, 12.45; p = 0.017) in the multivariate regression analysis. This result could assist the surgeon to identify patients at a high risk of developing POPF.
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Affiliation(s)
- Yun Hwa Roh
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo Kyeong Kang
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Soon-Young Song
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Chul-Min Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Yun Kyung Jung
- Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Mimi Kim
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
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Hirai T, Kobayashi H, Okuma T, Ishibashi Y, Ikegami M, Ohki T, Shinoda Y, Okajima K, Zhang L, Akiyama T, Goto T, Tanaka S. Skeletal muscle measurements predict surgical wound complications but not overall survival in patients with soft tissue sarcoma. Jpn J Clin Oncol 2020; 50:1168-1174. [PMID: 32533175 DOI: 10.1093/jjco/hyaa100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is unknown whether sarcopenia influences treatment outcome in patients with soft tissue sarcoma. Herein, we aimed to elucidate the impact of sarcopenia on sarcoma treatment. METHODS A total of 163 soft tissue sarcoma patients were included. Skeletal muscle measures were calculated using computed tomography images. Skeletal muscle area (SMA) and density (SMD) at the L3 level were extracted, and SMA was normalized by height as skeletal muscle index (SMI). The skeletal muscle gauge (SMG) was calculated by multiplying SMD × SMI. The relationship of skeletal muscle measures and clinical factors to wound complications and prognosis was evaluated, and classification and regression tree (CART) analysis was used to develop classification models for risk groups of surgical wound complications. RESULTS Thirty-three patients developed wound complications. In univariate analysis, age (P = 0.0022), tumour location of adductor compartment of the thigh (P = 0.0019), operating time (P = 0.010), blood loss (P = 0.030), SMD (P = 0.0004) and SMG (P = 0.0001) were significantly correlated with complications. In multivariate analysis, lower SMG was an independent risk factor (P = 0.031, OR = 3.27). CART analysis classified three risk groups of surgical wound complications by SMG, age, tumour location and operating time, and area under the receiver operating characteristic curve (AUROCC) was 0.75. SMG was not associated with prognosis in univariate analysis (P = 0.15). CONCLUSIONS The SMG does not affect overall survival but predicts surgical wound complications.
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Affiliation(s)
- Toshihide Hirai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomotake Okuma
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yuki Ishibashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masachika Ikegami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahiro Ohki
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Koichi Okajima
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Liuzhe Zhang
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahiro Goto
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Yokoyama Y, Nagino M, Ebata T. Importance of "muscle" and "intestine" training before major HPB surgery: A review. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:545-555. [PMID: 33058524 DOI: 10.1002/jhbp.835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/07/2023]
Abstract
Major hepato-pancreato-biliary (HPB) surgery is one of the most invasive abdominal surgeries. Through the experiences of several clinical trials, including those involving patients undergoing major HPB surgery, we have recognized the importance of "muscle" and "intestine" training before surgery. This review article summarizes the results of our clinical trials, specifically focusing on the importance of "muscle" and "intestine". The patients with low skeletal muscle mass or those with low functional exercise capacity showed a significantly worse postoperative course and poor long-term survival after surgery for HPB malignancy. The introduction of prehabilitation (preoperative physical and nutritional support) improved nutritional status and functional exercise capacity, even in patients with malignancy. Daily physical activity was correlated with nutritional status before surgery. These results indicated the usefulness of prehabilitation. The intestinal microenvironment, which is extrapolated from the fecal concentrations of short-chain fatty acids (SCFAs), showed a significant association with the incidence of surgery-induced bacterial translocation and postoperative infectious complications (POICs). The use of perioperative synbiotics not only increased the fecal levels of SCFAs but also prevented the incidence of POICs. A recent study also indicated that there are correlations between muscle mass and the intestinal microenvironment. Further investigation is required to determine the best "muscle" and "intestine" training protocol to improve the outcomes of major HPB surgeries.
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Affiliation(s)
- 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
| | - Masato Nagino
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Marasco G, Serenari M, Renzulli M, Alemanni LV, Rossini B, Pettinari I, Dajti E, Ravaioli F, Golfieri R, Cescon M, Festi D, Colecchia A. Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments. J Gastroenterol 2020; 55:927-943. [PMID: 32748172 PMCID: PMC7519899 DOI: 10.1007/s00535-020-01711-w] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/15/2020] [Indexed: 02/04/2023]
Abstract
Changes in body composition are associated with poor outcomes in cancer patients including hepatocellular carcinoma (HCC). Sarcopenia, defined as the loss of skeletal muscle mass, quality and function, has been associated with a higher rate of complications and recurrences in patients with cirrhosis and HCC. The assessment of patient general status before HCC treatment, including the presence of sarcopenia, is a key-point for achieving therapy tolerability and to avoid short- and long-term complications leading to poor patients' survival. Thus, we aimed to review the current literature evaluating the role of sarcopenia assessment related to HCC treatments and to critically provide the clinicians with the most recent and valuable evidence. As a result, sarcopenia can be predictive of poor outcomes in patients undergoing liver resection, transplantation and systemic therapies, offering the chance to clinicians to improve the muscular status of these patients, especially those with high-grade sarcopenia at high risk of mortality. Further studies are needed to clarify the predictive value of sarcopenia in other HCC treatment settings and to evaluate its role as an additional staging tool for identifying the most appropriate treatment. Besides, interventional studies aiming at increasing the skeletal muscle mass for reducing complications and increasing the survival in patients with HCC are needed.
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Affiliation(s)
- Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy.
| | - Matteo Serenari
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Matteo Renzulli
- Radiology Unit, Sant'Orsola Malpighi Hospital, Via Albertoni 4, 40138, Bologna, Italy
| | - Luigina Vanessa Alemanni
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Benedetta Rossini
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Irene Pettinari
- Radiology Unit, Sant'Orsola Malpighi Hospital, Via Albertoni 4, 40138, Bologna, Italy
| | - Elton Dajti
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Sant'Orsola Malpighi Hospital, Via Albertoni 4, 40138, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, University Hospital Borgo Trento, Verona, Italy
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Vugts JJA, Gaspersz MP, Roos E, Franken LC, Olthof PB, Coelen RJS, van Vugt JLA, Labeur TA, Brouwer L, Besselink MGH, IJzermans JNM, Darwish Murad S, van Gulik TM, de Jonge J, Polak WG, Busch ORC, Erdmann JL, Groot Koerkamp B, Buettner S. Eligibility for Liver Transplantation in Patients with Perihilar Cholangiocarcinoma. Ann Surg Oncol 2020; 28:1483-1492. [PMID: 32901308 PMCID: PMC7892510 DOI: 10.1245/s10434-020-09001-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Liver transplantation (LT) has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (pCCA) in the Mayo Clinic with a reported 5-year overall survival (OS) of 53% on intention-to-treat analysis. The objective of this study was to estimate eligibility for LT in a cohort of pCCA patients in two tertiary referral centers. METHODS Patients diagnosed with pCCA between 2002 and 2014 were included from two tertiary referral centers in the Netherlands. The selection criteria used by the Mayo Clinic were retrospectively applied to determine the proportion of patients that would have been eligible for LT. RESULTS A total of 732 consecutive patients with pCCA were identified, of whom 24 (4%) had PSC-associated pCCA. Overall, 154 patients had resectable disease on imaging and 335 patients were ineligible for LT because of lymph node or distant metastases. An age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible for LT. After applying the Mayo Clinic criteria, only 34 patients (5%) were potentially eligible for LT. Median survival from diagnosis for these 34 patients was 13 months (95% CI 3-23). CONCLUSION Only 5% of all patients presenting with pCCA were potentially eligible for LT under the Mayo criteria. Without transplantation, a median OS of about 1 year was observed.
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Affiliation(s)
- Jaynee J A Vugts
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marcia P Gaspersz
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eva Roos
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotte C Franken
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pim B Olthof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert J S Coelen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen L A van Vugt
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Tim A Labeur
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieke Brouwer
- Department of Gastroenterology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Marc G H Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen de Jonge
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wojciech G Polak
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Olivier R C Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris L Erdmann
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Stefan Buettner
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Lee BM, Cho Y, Kim JW, Jeung HC, Lee IJ. Prognostic Significance of Sarcopenia in Advanced Biliary Tract Cancer Patients. Front Oncol 2020; 10:1581. [PMID: 32984018 PMCID: PMC7492547 DOI: 10.3389/fonc.2020.01581] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/22/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Sarcopenia, systemic inflammation, and low muscularity significantly impact the survival of cancer patients. However, few studies have investigated how sarcopenia and systemic inflammation affect the prognosis of biliary tract cancer with distant metastasis. In this study, we investigated the association between sarcopenia with systemic inflammation and prognosis of metastatic biliary tract cancer. Materials and Methods: Data collected from 353 metastatic biliary tract cancer patients from 2007 to 2016 were analyzed. To evaluate the skeletal muscle mass, computed tomography images at the upper level of the third lumbar vertebra (L3) were used. Sarcopenia was defined using the Japan Society of Hepatology guideline; L3 muscle index <42 cm2/m2 for male and <38 cm2/m2 for female patients. Systemic inflammation was evaluated using the neutrophil lymphocyte ratio (NLR). Patients with NLR > 3 were categorized into the inflammatory category. The overall survival (OS) and progression free survival (PFS) were analyzed. Subgroup analysis was performed on those who received gemcitabine/cisplatin (GP) chemotherapy and depending on the presence of sarcopenia and inflammation. Results: Patients with sarcopenia showed lesser 1-year OS than those without (25.5 vs. 38.2%, p = 0.019). The patients with high NLR (NLR > 3) were associated with a shorter OS than were those with a low NLR (NLR ≤ 3) (21.0 vs. 52.8%, p < 0.001). Based on these results, we categorized the patients into three groups; sarcopenia accompanied by high NLR, no sarcopenia and low NLR, and either sarcopenia or high NLR. The OS of patients was well-stratified according to this grouping (1-year OS; 18.3 vs. 30.3 vs. 55.8%, p < 0.001). Concordant with OS results, the PFS was well-stratified based on the presence of either sarcopenia or high NLR (Sarcopenia; 9.5 vs. 19.4%, p < 0.001, NLR; 10.0 vs. 23.4%, p < 0.001). The PFS was significantly associated with high NLR and sarcopenia (1-year PFS; 7.8 vs. 13.0 vs. 27.9%, p < 0.001). Conclusion: Sarcopenia with inflammation was associated with inferior OS and PFS. In addition, sarcopenia accompanied by inflammation was associated with poor prognosis. Conservative treatments such as nutritional support, exercise, and pharmacologic intervention could help metastatic biliary tract cancer patients to overcome sarcopenia and the inflammatory status.
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Affiliation(s)
- Byung min Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hei Cheul Jeung
- Division of Medical Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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50
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Shiozawa T, Kikuchi Y, Wakabayashi T, Matsuo K, Takahashi Y, Tanaka K. Body composition as reflected by intramuscular adipose tissue content may influence short- and long-term outcome following 2-stage liver resection for colorectal liver metastases. Langenbecks Arch Surg 2020; 405:757-766. [PMID: 32851433 DOI: 10.1007/s00423-020-01973-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION For many kinds of cancer, body composition and immunonutritional status have been reported to influence postoperative outcome. We assessed their impact on short- and long-term outcome in patients with colorectal liver metastases who underwent 2-stage liver resections. METHODS Short- and long-term outcomes for 47 patients with 2-stage hepatectomies were assessed retrospectively in terms of data obtained before preoperative chemotherapy, before the first hepatectomy, and before the second hepatectomy. RESULTS Although immunonutritional status and body composition did not affect short-term outcome, high intramuscular fat content before the second hepatectomy was a poor prognostic factor for overall survival (HR, 5.829; 95% CI, 1.611-21.090; p = 0.007) and for recurrence-free survival (HR, 2.787; 95% CI, 1.301-5.973; p = 0.008). Patients with high intramuscular fat before the second hepatectomy also showed shorter intervals from recurrence to treatment failure. CONCLUSION Intramuscular fat before the second hepatectomy is an important negative prognosticator in 2-stage liver resection for colorectal liver metastases.
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Affiliation(s)
- Toshimitsu Shiozawa
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan
| | - Yutaro Kikuchi
- Department of Surgery, Division of Hepato-biliary-pancreatic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.,Departments of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsuji Wakabayashi
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan
| | - Kenichi Matsuo
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan.,Department of Surgery, Division of Hepato-biliary-pancreatic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Yuki Takahashi
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan
| | - Kuniya Tanaka
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan. .,Department of Surgery, Division of Hepato-biliary-pancreatic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan. .,Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
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