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.

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