Sarcopenia is characterized as a syndrome involving the progressive or generalized loss of skeletal muscle mass and strength with or without increased fat mass. This is one of well-known risk factors for adverse treatment outcomes in patients with various medical and surgical diseases. Sarcopenia itself, independent of the body mass index, is a powerful prognostic factor for cancer cachexia, liver cirrhosis, and even all causes of mortality. In terms of gastrointestinal surgery, sarcopenia is a significant prognostic factor in patients with gastric or colorectal cancers. Sarcopenia is related to postoperative complication, 30-day mortality, overall survival, and disease-free survival after gastrointestinal surgery. For patients with hepatic surgery, sarcopenia is also a significant prognostic factor. Several studies, including meta-analysis, proved sarcopenia to be waiting-list mortality and post-transplantation mortality in liver transplantation patients. Similarly, preoperative sarcopenic obesity was an independent risk factor for death and hepatocellular carcinoma recurrence after a hepatectomy. In cases of pancreatic cancer, several studies proposed that sarcopenia was an objective measure of patient frailty that was strongly associated with the long-term outcome independent of tumor-specific factors. In addition, sarcopenia or sarcopenic obesity has been reported to be a strong predictor of major complications after pancreatectomy. As a result, sarcopenia could be used to improve patient selection before a pancreatectomy. The next step to solve the questions to manage sarcopenia and improve the post-pancreatectomy outcomes would be to determine the role of nutrition and physical activity in the prevention or treatment of sarcopenia, and to develop specific medications with an evidence-based treatment of sarcopenia in patients with pancreatectomy.

Citations

Citations to this article as recorded by  

• Major Surgery in Sarcopenic Patients
  Kyung Won Seo
  Surgical Metabolism and Nutrition.2019; 10(1): 5.     CrossRef

In terms of nutritional therapy after pancreatectomy, there is no need for routine use of artificial nutrition supplementation except in the case of malnutrition or complications. Postoperative pancreatic fistula (POPF) is one of the most representative complications of pancreatectomy, and adequate nutritional support is important for management of POPF. Oral diet or enteral nutrition (EN) treatment is preferred over parenteral nutrition (PN) since oral diet or EN results in higher POPF closure rates and lower complication rates than EN. Postoperative pancreatitis is usually managed according to the general principle of acute pancreatitis. There is no need to provide specialized nutrition therapy for mild pancreatitis, whereas moderate-to severe pancreatitis should be treated with early specialized nutritional therapy. EN is a more preferred nutritional supplement method over PN due to its lower complication rate, shorter hospital stay, less frequent multi-organ failure, and mortality. Long-term sequelae after POPF or pancreatitis include exocrine or endocrine insufficiency. In the case of exocrine insufficiency, exocrine replacement therapy should be administered. Moreover, endocrine insufficiency, commonly represented by diabetes mellitus (DM), should be managed based on guidelines for type 1 or 2 DM.