| PurposeTo explore the effect of the 3rd lumbar vertebral plane skeletal muscle mass index(L3 SMI)on preoperative nutritional status of patients with gastric cancer and the adverse effect of skeletal muscle loss on postoperative outcomes,analyze the predictive effect of L3 SMI on postoperative complications.MethodsPatients with gastric cancer admitted to the department of gastrointestinal surgery of Xijing hospital affiliated to the air force military medical university from September 2016 to June 2017 were retrospectively analyzed.A total of 232 patients,aged 24~83(58.43±10.73)years,were included.All of them had received abdominal enhanced CT examination before surgery.The mass index of skeletal muscle mass in the 3rd lumbar spine plane was calculated by measuring the total area of skeletal muscle groups(mainly including erector spinalis,lumbar maximus,quadratus lumbar,transverse abdominis,internal oblique,external oblique and rectus abdominis),and the ratio of these muscle groups to the square of height.Patients were divided into High skeletal muscle mass index group(High-SMI)and Low skeletal muscle mass index group(Low-SMI)based on the lowest quartile values.Preoperative case data of patients were collected,including laboratory examination indexes,NRS2002 score and PG-SGA score,etc.Baseline data between the two groups were compared using t test,The correlation between L3 skeletal muscle mass index and malnutrition in patients with gastric cancer was evaluated by ?2 test,and the correlation between L3 skeletal muscle mass index and nutritional risk of patients was analyzed by spearman.Finally,the independent risk factors of postoperative complications are determined through the single factor and multi-factor Logistic regression analysis of the related factors of postoperative complications of gastric cancer patients.ResultsAccording to the grouping method of this study,there were 58 patients in the Low-SMI group with an average age of 61.62±10.8 years old,and 174 patients in the High-SMI group with an average age of 57.24±10.57 years old.The age difference between the two groups was statistically significant(P=0.007,P?0.05),the older the person,the lower the skeletal muscle mass index.There were no significant differences in gender,surgical factors and tumor characteristics between the two groups.In the comparison of nutritionally related laboratory indexes between the two groups,preoperative BMI,serum total protein(TP),serum albumin(ALB)and hemoglobin(HGB)of the group with low skeletal muscle mass index were lower,and the differences between the two groups were statistically significant(P?0.05).According to the preoperative PG-SGA score,the difference between the two groups was statistically significant(?2=28.78,P ?0.05).Spearman correlation analysis with NRS2002 nutrition risk screening tool showed that L3 SMI was negatively correlated with nutrition risk score,L3 SMI was about low,and the preoperative nutrition risk of patients was higher(r=-0.713,p < 0.05).The results of univariate analysis showed that gender surgical method,gastric resection range and L3 skeletal muscle mass index were the related factors affecting the incidence of postoperative complications after radical gastrectomy.Multivariate analysis showed that L3 SMI was an independent risk factor for complications after radical gastrectomy.The risk of postoperative complications was significantly higher in patients with low skeletal muscle mass index than in patients with high skeletal muscle mass index(95%CI,1.978–5.211;P = 0.002).ConclusionL3 SMI is an influencing factor of nutritional risk in patients with gastric cancer,which is associated with preoperative malnutrition in patients with gastric cancer,and should be included in the routine preoperative nutritional assessment system for patients with gastric cancer.In addition,L3 SMI is an independent risk factor for postoperative complications in patients with gastric cancer,and the lower the preoperative L3 SMI value,the higher the incidence of postoperative complications. |
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