The association between skeletal muscle mass index (SMI) and survival after gastrectomy: A systematic review and meta-analysis of cohort studies

The impact of preoperative skeletal muscle mass index-defined sarcopenia on postoperative complications and survival in gastric cancer: An updated meta-analysis

BACKGROUND

The impact of preoperative sarcopenia on postoperative outcomes in gastric cancer remains debated. This study aims to perform an in-depth meta-analysis and comprehensive review of the relationship between preoperative sarcopenia, as assessed by the Skeletal Muscle Mass Index (SMI), and postoperative complications and survival metrics in gastric cancer patients, to offer new insights into this issue.

METHODS

We conducted a systematic search of primary studies in databases such as Embase, PubMed, and Web of Science, up to July 2024. Our analysis focused on comparing postoperative readmission and mortality rates, overall and severe complication rates, incidence of specific complications, as well as overall survival (OS) and disease-free survival (DFS) between groups with and without preoperative sarcopenia.

RESULTS

Our review included 42 studies with a total of 11,981 patients. Findings revealed that patients with sarcopenia had significantly higher rates of overall postoperative complications, severe complications, mortality, and readmissions compared to those without sarcopenia (all P < 0.001). A detailed examination showed that sarcopenic patients had notably higher incidences of pulmonary complications, bowel obstruction, and pancreatic fistulas. Additionally, the OS (P < 0.001) and DFS (P = 0.003) rates were considerably lower in the sarcopenia group.

CONCLUSIONS

Preoperative sarcopenia is associated with an increased risk of postoperative complications and poorer survival outcomes in gastric cancer patients. Given these associations, it is recommended to incorporate routine screening for sarcopenia using SMI before surgery, where feasible, to enhance patient risk assessment and customize treatment approaches.

Postoperative skeletal muscle loss as a prognostic indicator of clinical outcomes in patients with gastric cancer: a systematic review and meta-analysis

BACKGROUND

A decrease in skeletal muscle mass is frequently observed during the perioperative period in patients with gastric cancer (GC) and is strongly associated with postoperative complications and poor long-term survival outcomes. Relevant research indicates that a certain proportion of patients with GC experience skeletal muscle mass loss after surgery. Therefore, a systematic review and meta-analysis was conducted to assess postoperative skeletal muscle loss as a prognostic marker for clinical outcomes in patients with GC.

METHODS

PubMed, Web of Science, and Embase were used to systematically screen and retrieve relevant studies according to strictly established inclusion and exclusion criteria. Further analysis of the effect of postoperative skeletal muscle loss on long-term survival metrics (including overall survival [OS], recurrence-free survival [RFS], disease-free survival [DFS], and disease-specific survival [DSS]) in patients with GC was performed.

RESULTS'

From 10 studies and 11 related publications, more than 3764 patients with GC were identified. Severe postoperative skeletal muscle loss occurred in 25.7% of patients with GC and was significantly correlated with poorer OS (hazard ratio [HR], 2.27; 95% CI, 1.58-3.25; P <.00001), RFS (HR, 2.96; 95% CI, 1.47-5.97; P =.002), DFS (HR, 2.41; 95% CI, 1.17-4.97; P =.02), and DSS (HR, 4.12; 95% CI, 2.44-6.94; P <.00001). When postoperative skeletal muscle loss advanced to sarcopenia, patients had worse OS as well (HR, 2.22; 95% CI, 1.49-3.30; P <.0001).

CONCLUSION

Patients who undergo radical surgery for GC often experience skeletal muscle mass loss, and significant skeletal muscle mass loss is associated with poorer survival outcomes. Identifying patients with significant skeletal muscle mass loss during follow-up and promptly providing tailored interventions, such as nutritional and exercise support, are essential.

Prevalence of Sarcopenia Determined by Computed Tomography in Pancreatic Cancer: A Systematic Review and Meta-Analysis of Observational Studies

Introduction: Sarcopenia, a condition characterized by a loss of skeletal muscle mass, is increasingly recognized as a significant factor influencing patient outcomes in pancreatic cancer (PC). This systematic review and meta-analysis aimed to estimate the prevalence of sarcopenia in patients with PC using computed tomography and to explore how different measurement methods and cut-off values impact such prevalence. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search of PubMed, Web of Science, and EMBASE databases was performed, identifying 48 observational studies involving 9063 patients. Results: The overall pooled prevalence of sarcopenia was 45% (95% CI, 40-50%), but varied significantly by the method used: 47% when measured with the skeletal muscle index and 33% when assessed with the total psoas area. In addition, in studies using SMI, sarcopenia prevalence was 19%, 45%, and 57% for cutoff values <40 cm2/m2, 40-50 cm2/m2, and >50 cm2/m2, respectively. Moreover, the prevalence was higher in patients receiving palliative care (50%) compared to those treated with curative intent (41%). High heterogeneity was observed across all analyses, underscoring the need for standardized criteria in sarcopenia assessment. Conclusions: Our findings highlight the substantial variability in sarcopenia prevalence, which could influence patient outcomes, and stress the importance of consensus in measurement techniques to improve clinical decision making and research comparability.

Postoperative sarcopenia increases both gastric cancer and other-cause mortality in older adults undergoing radical gastrectomy for cancer

BACKGROUND & AIMS

Preoperative sarcopenia in gastric cancer is associated with increased postoperative complications and reduced long-term survival. However, the association between postoperative sarcopenia and long-term outcomes remains unclear. Therefore, this study aims to clarify the association between sarcopenia after gastrectomy for gastric cancer and survival outcomes.

METHODS

This retrospective study included 1512 patients aged ≥65 who underwent curative gastric resection for clinical stage I-III primary gastric cancer during 2008-2018. Sarcopenia was assessed preoperatively by measuring arm muscle area and grip strength, which was repeated 1 month after surgery. We compared the clinical characteristics, surgical treatments, and long-term outcomes between the postoperative normal and sarcopenia groups.

RESULTS

Sarcopenia was observed in 173 and 305 patients pre- and postoperatively, respectively. Factors increasing the risk of postoperative sarcopenia included age of ≥75, lower preoperative body mass index, diabetes, and clinical stage II/III gastric cancer. Patients with postoperative sarcopenia after surgery had a significantly lower overall survival rate (hazard ratio [HR] 2.596, p < 0.001). Furthermore, postoperative sarcopenia was linked to decreased overall survival in patients with (HR 2.813, p = 0.002) and without (HR 1.925, p < 0.001) preoperative sarcopenia. Cumulative incidence showed significantly higher rates of deaths due to gastric cancer (HR 1.928, p < 0.001) and other causes (HR 2.736, p < 0.001) in the postoperative sarcopenia group.

CONCLUSIONS

Postoperative sarcopenia in gastric cancer is linked to an increased risk of death due to cancer and other causes, underscoring the importance of perioperative sarcopenia management strategies.