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Clinical Impact of Preoperative Sarcopenia to Postoperative Prognosis in Patients with Periampullary Malignancy: Retrospective Multicenter Study
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Jee Hyun Park, Youngju Ryu, So Hee Song, Naru Kim, Sang Hyun Shin, Jin Seok Heo, Dong Wook Choi, Woo Kyoung Jeong, Woo Hyun Jung, Yong Chan Shin, Chang-Sup Lim, In Woong Han
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Surg Metab Nutr 2020;11(2):40-45. Published online December 30, 2020
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DOI: https://doi.org/10.18858/smn.2020.11.2.40
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 Abstract
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- Purpose: This study compared the preoperative nutritional status between sarcopenic and non-sarcopenic patients and examined the effects of sarcopenia on the prognosis after a pancreatoduodenectomy (PD).
Materials and Methods: From 2015 to 2016, 480 patients who underwent PD with periampullary cancer at Samsung Medical Center, Seoul National University Boramae Medical Center, Ilsan Paik Hospital, and Ajou University Hospital were analyzed retrospectively. Sarcopenia was measured from the cross-sectional visceral fat and muscle area on CT imaging using an automatic calculation program. The dysnutritional grade was assessed according to Controlling Nutritional Status (CONUT) score system.
Results: Preoperative serum albumin (3.9 g/dl) and cholesterol levels (161.7 mg/dl) of sarcopenic patients were significantly lower than those of the non-sarcopenia patients (4.0 g/dl, P=0.024; 176.1 mg/dl, P=0.005). The proportion of moderate-to-severe dysnutritional grade in sarcopenic patients was significantly higher than in the non-sarcopenic patients (20.0 vs. 8.1%, P=0.004). A comparison of the changes in albumin between before and after PD showed a decrease in sarcopenic patients (0.06 vs. 0.05, P=0.024). Sarcopenia itself was not a factor affecting the overall survival (OS) negatively, but moderate-to-severe dysnutritional grade was an independent risk factor for OS (HR 2.418, CI 1.424~4.107, P=0.001).
Conclusion: Patients with sarcopenia showed poorer preoperative nutritional status than those without sarcopenia, and the sarcopenia affected the postoperative nutritional status negatively. No direct correlation was observed between sarcopenia and OS, but the dysnutritional grade was an independent risk factor that affects OS. As a result, patients with sarcopenia could be affected indirectly for survival because of their poor nutritional status.
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