Adverse Effects of Low Preoperative Skeletal Muscle Mass in Patients Undergoing Gastrectomy for Gastric Cancer.

Abstract

The aim of this study was to determine the impact of preoperative skeletal muscle mass on short- and long-term outcomes of patients with gastric cancer (GC) who undergo gastrectomy. A total of 569 patients subjected to gastrectomy for GC at our institution between January 2007 and December 2013 were reviewed and skeletal muscle index (SMI) was measured via cross-sectional, image-based muscle assessment. Computed tomography (CT) and the volume analyzer SYNAPSE VINCENT were required. Patients were divided into two groups, with the first quartile serving as the cut-point for both men and women. Clinicopathologic features and short- and long-term outcomes were compared. In multivariate analysis, SMI emerged as an independent predictor of 5 year overall survival (OS) and cancer-specific survival (CSS) in patients with GC. In subgroup analysis, by stage, patients with stage I disease and low (vs. high) SMI demonstrated significantly worse 5 year OS. The incidence of postoperative complications did not differ significantly by group. Preoperative SMI, measured in cross-section using CT, is a useful nutritional determinant that may predict OS and CSS in patients with GC who undergo gastrectomy. In our view, nutritional support for sarcopenic patients with stage I GC, aimed at retaining or adding skeletal muscle mass, may improve survival. Our analysis showed no relationship between preoperative SMI and postoperative complications.