Y. Yamazaki1, S. Kanaji1, G. Takiguchi1, H. Hasegawa1, M. Yamamoto1, Y. Matsuda1, K. Yamashita1, T. Oshikiri1, T. Matsuda1, T. Nakamura1, S. Suzuki1, Y. Kakeji1 1Kobe University Graduate School Of Medicine,Division Of Gastrointestinal Surgery, Department Of Surgery, Kobe University Graduate School Of Medicine,Kobe, HYOGO, Japan
Introduction:
Gastrectomy is an essential treatment for gastric cancer. However, it is well known that gastrectomy causes not only body weight loss (BWL) but also skeletal muscle loss (SML), which can impair quality of life of the patients. Several reports showed the type of open gastrectomy had an effect on BWL and SML. However, the difference in SML between types of laparoscopic gastrectomy and correlation between BWL and SML are still unclear. The aim is to reveal the differences in SML between laparoscopic procedures for gastric cancer and to identify the risk factors for SML.
Methods:
We retrospectively obtained data of 207 consecutive patients who underwent laparoscopic gastrectomy for gastric cancer between March 2011 and May 2017. Out of the patients, 157 patients underwent laparoscopic distal gastrectomy (LDG group) and 50 patients underwent laparoscopic total gastrectomy (LTG group). We analyzed psoas major muscle area (PMA) of the L3 for evaluation of skeletal muscle mass using CT image taken before the surgery and at 1 postoperative year and compared PMA change between the laparoscopic procedures. Comparisons of BW and PMA were performed between the types of laparoscopic procedures including LDG (Billroth 1), LDG (Roux en Y) and LTG. Univariate and multivariate analysis to identify risk factors for PMA rate of less than 90% were performed for LDG group. Further, we performed the same analysis for the population whose BW was relatively preserved.
Results:
There was no significant difference in the characteristics. Longer operative time and more blood loss were observed in LTG group. Pathological findings showed more advanced diseases in LTG group, which resulted in more adjuvant chemotherapy undergone. Anastomotic leakage in LTG group was more frequent, while the overall complications rate was not different. The median PMA rate (1POY / Pre) was 94.0% in LDG (B-1), 95.2% in LDG (R-Y) and 84.4% in LTG group respectively. BW and PMA were preserved significantly better in both LDG subgroups. Univariate analysis showed that high BMI (25 or above) and postoperative complications were significantly associated with more PMA loss, while multivariate analysis identified only postoperative complications as an independent risk factor in LDG group. BW and PMA rate were well correlated in overall patients, and PMA rate of 90% was equivalent to BW rate of 88%. Out of 118 patients whose BW rates was 88% or above, 29 patients had their PMA rate fall below 90%. Univariate and multivariate analysis showed that LTG was the independent risk factor for PMA rate less than 90 % in patients whose BW rate was 88% or larger.
Conclusion:
We showed that postoperative PMA loss occurred in laparoscopic gastrectomy as well as previous reported open surgery. Postoperative complications were harmful for SML after LDG. Because LTG can cause great PMA loss even when BW are relatively preserved, SML should be cared especially after LTG.