| Objective:With advances in medical technology,especially enhanced recovery after surgery,clinical nutritional support and treatment,and minimally invasive techniques,the safety of surgical procedures has been greatly improved and the quality of life of patients has also been greatly improved.However,surgical treatment still has a certain complication rate and even mortality,especially in the treatment of malignant tumors such as gastric cancer.Gastric cancer(GC)is the fifth most common cancer in the world and the third leading cause of cancer death.With the progress of medicine,the prognosis of patients with gastric cancer has been improved,but the prognosis is still poor.Surgical resection is still the most effective treatment for potentially cancerous gastric cancer.Gastric cancer occurs mainly in elderly patients,while older patients are at a higher risk of adverse outcomes after surgery compared with younger patients.In addition,the incidence of malnutrition in gastric cancer patients is high due to the consumption of nutrients by malignant tumors,the metabolic abnormalities caused by toxins released,the gastrointestinal obstruction and the treatment side effects.Patients with gastric cancer are also accompanied by a higher incidence of cachexia.One of the basic features of cancerous cachexia is the persistent chronic inflammatory response.Tumor cells produce proinflammatory and secretagogue factors that stimulate the host’s inflammatory response.These lead to skeletal muscle loss through a variety of mechanisms.Gastric cancer patients with aging,malnutrition,prone to cancer,cachexia,associated with other underlying diseases and other characteristics,leading to muscle stenosis in patients with gastric cancer prevalence.According to an expert consensus released by the EWGSOP,sarcopenia is defined as a syndrome characterized by progressive generalized skeletal muscle mass loss and decreased function that can lead to various adverse clinical outcomes such as physical disability,declining quality of life and even death.It has been reported in the literature that muscle stenosis is an independent predictor of the prognosis of many types of gastrointestinal cancer including gastric cancer.However,studies have drawn different conclusions.Therefore,the effect of muscular dystrophy on postoperative gastric cancer remains controversial.At the same time,the evaluation of skeletal muscle quality is controversial.Although CT scanning and MRI are regarded as the gold standard for muscle quality assessment,the high cost and inconvenience of operation limit their clinical application.Dual-energy X-ray absorptiometry(DXA)and bioelectrical impedance analysis(BIA)are easier ways.Previous studies have confirmed the accuracy of BIA in the diagnosis of sarcopenia,and the skeletal muscle mass measured by BIA has also been recommended by EWGSOP.This study will investigate the effect of preoperative skeletal muscle mass on clinical outcomes after radical resection of gastric cancer patients,and clarify the role of muscle reduction as a risk factor for poor outcome after radical surgery in patients with gastric cancer.To further improve the perioperative treatment of gastric cancer patients and provide the basis for the safety of surgery.METHODS:This prospective cohort study included patients with concurrent radical surgery diagnosed as gastric cancer in the General Surgery,Nanjing General Hospital,People’s Liberation Army.We measured all patients’ weight and height,and calculate the BMI when they were admitted to the hospital.Patients were screened for NRS2002.Skeletal muscle mass was measured by bioelectrical impedance analysis(BIA).Skeletal muscle index was calculated by the following formula,skeletal muscle index SMI(kg/m2)= skeletal muscle mass SM(kg)/height(m2).The clinical data of patients were collected prospectively to observe the effect of sarcopenia on the postoperative clinical outcomes(complications,postoperative hospital stay,postoperative hospitalization costs and re-admission rates).Univariate analysis and multivariate logistic regression analysis were used to find the related risk factors of postoperative complications in gastric cancer patiens.Results:Between February 2016 and September 2017,a total of 93 gastric cancer patients met the inclusion criteria and were included in the analysis.67 males(72.04%)and 26 females(27.96%).The median age of patients was 60 and the risk of malnutrition was 58(NRS 2002 score ≥ 3),with a prevalence of 62.4%.Twenty-four patients were diagnosed as sarcopenia with a rate of 25.81%(24/93)The incidence of sarcopenia was 25.37%(17/67)in women and 26.92%(7/26)in women.The mean BMI was lower in patients with sarcopenia compared with those without sarcopenia(20.49 ± 2.66 VS 23,97 ± 3.05,p<0.001).The incidence of nutritional risk(79%)was higher than that of non-sarcopenia group(42%).The insulin-like growth factor-1(96.24±43.57 vs 128.13 ±64.37),The mean serum albumin level was lower(40.44±4.11 vs 43.39±4.81)in patients with sarcopenia and the average prealbumin concentration was lower(160.30±42.64 vs.227.06±60.74),The mean retinaldehyde binding protein concentration was lower(26.59±12.84 vs 34.48±14.26)than the non-sarcopenia patients.Sex,age,history of diabetes,hemoglobin,inflammatory markers,renal function,blood,Blood lipids and other indexes had no significant difference.Two groups of patients underwent standard D2 radical gastrectomy.There was no significant difference in patients with sarcopenia compared with non-sarcopenia patients in surgical methods,resection range.The total complications(45.83%vs 11.59%),pleural effusion(16.67%vs 0%),incidence of intra-abdominal infection(20.83%vs 4.35%)were significantly increased in patients with sarcopenia.The number of postoperative hospital stay(13.17±9.11 vs 8.91±4.22)was significantly longer than that of the patients without sarcopenia.Univariate analysis and multivariate analysis showed that the prevalence of muscular dystrophy,age>60 years and preoperative nutrition risk(NRS2002>3)were independent risk factors for postoperative complications.Conclusion:According to the evaluation criteria of the Asian sarcopenia group,there is a higher incidence of sarcopenia in patients with gastric cancer before surgery,sarcopenia is a risk factor for postoperative complications in patients with gastric cancer.Because the BIA evaluation of sarcopenia simple,non-radioactive,the price is lower,it is recommended as a preoperative sarcopenia evaluation tool. |
PDF Full Text Request