Adverse effects of preoperative sarcopenia on postoperative complications of patients with gastric cancer

Abstract

Background: Sarcopenia is known to have an important influence on postoperative complications in several diseases, and on the prognosis of patients with cancer. However, whether sarcopenia is associated with complications and prognosis after gastrectomy in patients with gastric cancer remains controversial. This study evaluated the impact of the preoperative muscle mass on postoperative complications of gastric cancer surgery. Materials and Methods: The muscle mass of 153 patients who underwent gastrectomy for gastric cancer from January 2014 to August 2016 was assessed before surgery by a multifrequency bioelectrical impedance analysis (In Body 3.0; Biospace, Tokyo, Japan) and was expressed as the muscle mass index (MMI). Sarcopenia was defined as an MMI value of one standard deviation or more below the gender-specific mean MMI. Complications of Clavien–Dindo grade 2 or more were defined as significant postoperative complications. The impact of preoperative sarcopenia on postoperative infectious complications was analyzed by univariate and multivariate analyses. Results: A total of 153 patients were analyzed, sarcopenia was present in 24 out of 153 patients (15.7%). Thirty (19.6%) patients developed postoperative complications, 20 (13.1%) of which were infectious complications. Sarcopenia was significantly associated with age, body mass index, serum albumin, pulmonary disease in comorbidities, operative time, surgical approach, and postoperative complications. The univariate analyses revealed that male sex, sarcopenia, total gastrectomy, laparotomy, and intraoperative blood loss were associated with postoperative infectious complications. In the multivariate analyses, sarcopenia and intraoperative blood loss ≥400 ml were independently associated with postoperative infectious complications. Conclusion: Preoperative sarcopenia was found to be an independent risk factor for postoperative infectious complications in gastric cancer patients.