| BackgroundGastric cancer(GC)is one of the most common malignant tumors in China.Morbility and mortality are second and third respectively,which seriously threaten people's health.At present,the treatment of gastric cancer is a comprehensive treatment based on surgery,which is still the most important method to treat gastric cancer.The occurrence of surgical complications(infectious diseases,anastomotic leakage,gastroparesis,enteroparalysis,etc.)is an important factor leading to poor prognosis.As we all know,the occurrence of postoperative complications is related to many factors,among which the general nutritional status of patients before operation is an important factor.Research shows that preoperative nutritional status of cancer patients is not only related to the incidence of complications,but also affects the long-term prognosis of patients.At present,there are a number of tools and indicators used to evaluate nutritional status in clinical work,such as body mass index((BMI)),serum albumin and NRS2002 scoring system.In recent years,people use computer tomography(CT)to observe human body composition,compared with BMI,CT can more directly and objectively evaluate the content of skeletal muscle and fat;in addition,CT scanning can also measure the CT value of muscle in the area,which indirectly reflects the density of skeletal muscle,so the content and density of skeletal muscle as a new index to evaluate nutritional status has been paid more and more attention.ObjectivesThe purpose of this study is to use CT to measure the content and density of skeletal muscle in patients undergoing laparoscopic gastrectomy,to clarify the important value of the content and density of skeletal muscle as an indicator of nutritional status,and to study the relationship between the attenuation of the content and density of skeletal muscle and the postoperative complications.MethodsFrom January 2017 to December 2018,409 patients with GC who underwent laparoscopic gastrectomy in gastrointestinal surgery of Provincial Hospital Affiliated to Shandong University were analyzed retrospectively.The cross-sectional area and CT value of bilateral psoas muscle were measured at the level of spinous process of the third lumbar vertebra(L3)by CT before operation.The average cross-sectional area and CT value of the bilateral psoas muscle were calculated.The diagnosis of skeletal muscle reduction was based on L3 psoas muscle index(PMI;PMI<6.36 cm2/m2 in men and 3.92 cm2/12 in women).The diagnosis of muscle density attenuation was based on the average CT value of L3 psoas muscle(MA<44.4 Hounsfield units(HU)in male,Ma<39.3 Hu in female).The diagnostic standard of obesity is body mass index(BMI)? 25 kg/m2.The basic clinical features,blood examination results,pathological results,postoperative complications and hospital stay of 409 patients with gastric cancer were collected by the medical record system.This study was approved by the ethics committee of the Provincial Hospital Affiliated to Shandong University.ResultsIn this study,409 patients with gastric cancer who underwent laparoscopic gastrectomy were included.The ratio of male to female was 3.2:1.0,and the total complication rate was 15.16%(n=62).265(64.8%)patients had skeletal muscle reduction.Skeletal muscle reduction was significantly correlated with age(OR:1.076;95%confidence interval(95%CI):1.050-1.103;P<0.0001),body mass index(OR:0.676;95%CI:0.580-0.788;P<0.0001),nutritional risk screening 2002(NRS 2002)score(OR:1.611;95%CI:1.189-2.183;P=0.002)and leukocyte count(OR:1.21;95%CI:1.039-1.409;P<0.014).58 patients(14.18%)suffered from muscle density decline.-3.803;P<0.00 01)relevant.There was no significant difference in sex,albumin,lymphocyte count,pathological tissue type,TNM stage and hospital stay between the skeletal muscle reduction group and the non-skeletal muscle reduction group.There was no significant difference in sex,blood biochemical index and hospitalization time between the MA group and the non-MA group.The results showed that the decrease of skeletal muscle density was not related to postoperative complications.NRS2002 score and albumin level were related to the incidence of postoperative complications.In subgroup analysis,the incidence of postoperative complications in patients with obese skeletal muscle reduction was significantly higher than that in patients with only skeletal muscle reduction(P<0.0001).In addition,severe skeletal muscle reduction was significantly associated with postoperative complications(P<0.0001).ConclusionsPreoperative skeletal muscle reduction and/or skeletal muscle density decline do not affect the incidence of complications after laparoscopic gastrectomy.Sarcopenic obesity and severe skeletal muscle reduction are the risk factors of complications after laparoscopic gastrectomy. |
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