C. S. Lau1, R. S. Chamberlain1,2 1Abrazo Central Hospital, Abrazo Community Health Network,Phoenix, AZ, USA 2Cancer Surgical Services Division, Valley Surgical Clinics,Phoenix, AZ, USA
Introduction: Sarcopenia is the progressive loss of skeletal muscle mass and strength and has long been accepted as an age related process. Sarcopenia is also frequently observed among cancer patients and has been reported to affect as many as 57.7% of gastrointestinal (GI) cancer patients. This meta-analysis examines the impact of sarcopenia on surgical outcomes in GI cancer patients.
Methods: A comprehensive literature search of all published studies evaluating the impact of sarcopenia on GI cancer patients undergoing surgery was conducted using PubMed, Cochrane Central Registries of Controlled Trials, and Google Scholar. Keywords searched included combinations of ‘sarcopenia’, ‘gastrointestinal’, ‘gastric’, ‘colorectal’, ‘hepatic’, ‘pancreatic’, ‘cancer’, ‘surgery’, and ‘outcomes’. Outcomes analyzed included total complications, major complications (Clavien-Dindo grade ≥3), in-hospital/30-day mortality, 30-day readmission rates, length of stay, and hospital costs.
Results: Fifty studies including 14,531 patients (4,774 sarcopenia and 9,757 no sarcopenia) were analyzed. Patients with sarcopenia were 1.619 times more likely to develop complications (OR 1.619; 95% CI, 1.340-1.956; p<0.001), and 1.536 times more likely to develop major complications (Clavien-Dindo grade ≥3) (OR 1.536; 95% CI, 1.289-1.830; p<0.001) compared to those without sarcopenia. Sarcopenia was also associated with higher rates of mortality (OR 1.558; 95% CI, 1.145-2.120; p=0.005), 30-day readmissions (OR 1.425; 95% CI, 1.061-1.915, p=0.019) and longer lengths of stay (MD 1.450 days; 95% CI, 0.816-2.083; p<0.001). Total hospital costs were significantly higher among those with sarcopenia (MD = $1,478.85 USD; 95% CI, $106.21 – 2,851.49; p=0.035). Although poorer outcomes were seen among all types of cancers (gastric, colorectal, hepato-pancreatic), differences between sarcopenic and non-sarcopenic groups were greatest among those with gastric cancer.
Conclusion: Sarcopenia is associated with a significant increase in total complications, major complications, mortality, 30-day readmissions, length of stay, and hospital costs. Sarcopenia is a poor prognostic factor in GI cancer patients undergoing surgery, and preoperative muscle mass assessments may have significant value in predicting and improving patient outcomes.
