The Relationship Between Muscle And Fat Content And Postoperative Complications In Gastric Cancer Patients With Cachexia

Objectives: To discuss the change of muscle and fat content in gastric cancer patients with cachexia,compare and analyze the relationship between muscle and fat content and the postoperative complications in gastric cancer patients with cachexia.Methods: The clinical data of 169 patients undergoing radical gastrectomy from January 2016 to May 2017 were retrospectively analyzed.All patients underwent total abdominal CT examination before surgery.Patients were divided into cachexia group and non-cachexia group according to the diagnostic criteria of "Guidelines for Nutritional Treatment of Cancer Cachexia".Quantificationally measure the skeletal muscle area(SMA),total fat area(TFA),visceral fat area(VFA)and subcutaneous fat area(SFA)at midpoint of the third lumbar by CT,and make them divided by the square of the height of the patient.According to gender,the lower quartiles(Q25)were taken as the cut-off value for judging whether those cachexia patients have muscle loss(fat loss)or not.The severity of postoperative complications was graded by the Clavien–Dindo scoring system.Nutritional risk screening 2002(NRS2002)and Patient-Generated Subjective Global Assessment(PG-SGA)were used to evaluate nutritional status of patients.Rank correlation analysis was used to analyze the relationship between muscle and fat content and NRS2002 and PG-SGA.Univariate and multivariate logistic regression models were used to analyze the factors associated with postoperative complications and to compare the effects of muscle and fat content on postoperative complications.P < 0.05 was considered to be statistically significant.Results: Cachexia occurred in 46 patients(27.2%),of which 30 patients(65.2%)had postoperative complications of varying degrees.The incidence of complications in cachexia patients was significantly higher than that in noncachexia patients(65.22% vs 35.77%,P=0.0006).The incidence of complications in cachexia patients with fat reduction was significantly higher than that in non-cachexia patients(82.61%vs 47.83%,P=0.0133).Muscle and fat content were negatively correlated with NRS2002 and PG-SGA(r <1,P <0.01).Univariate logistic regression analysis showed that tumor diameter,cachexia,muscle loss,and fat loss were related factors for postoperative complications.Multivariate logistic regression analysis showed that intraoperative blood loss and cachexia were independent risk factors for postoperative complications.Conclusions:The muscle content and fat content of gastric cancer patients with cachexia are significantly reduced.Cachexia patients with fat loss are more likely to have postoperative complications.Muscle and fat content are closely related to NRS2002 and PG-SGA.A lower content of the muscle and fat shows a higher score in NRS2002 and PG-SGA and the worse nutritional status.Using CT to measure the abdominal skeletal muscle and fat content of gastric cancer patients can better judge the nutritional status,predict the occurrence of complications,and integrate it with NRS2002 and PG-SGA into the preoperative nutritional evaluation system is helpful to clarify the direction of clinical nutritional support treatment and achieve the effect of improving clinical outcomes.