Relación entre la obesidad sarcopénica tras gastrectomía por cancer gástrico localmente avanzado y complicaciones postoperatorias mayores y su impacto en la supervivencia

Resumen

Introduction: The prevalence of sarcopenia in gastric cancer (GC), although varying among reported studies, is around 60%. In recent years, it has been recognised that sarcopenia may occur not only in patients with weight loss and low body weight but also in patients with a standard or increased body mass index. Sarcopenic obesity (SO) is a new definition that broadens the implications of altered body composition. This study aimed to assess the impact of SO on perioperative morbidity and survival of GC patients undergoing surgery by assessing body composition on Computed Tomography (CT) images. Materials and Methods: Patients operated on for gastric cancer with curative intent from January 2012 to December 2019 were included. Preoperative CT images were obtained for all patients. Fat and muscle measurements were performed on a preoperative contrast-enhanced CT cross-section at the third lumbar vertebra (L3). Skeletal muscle mass index (sum of muscle area at this level (cm2) normalised by the square of the patient’s height (m2)) and visceral adipose tissue crosssectional area (cm2) were calculated. Sarcopenia, obesity, and OS were calculated accordingto gender-specific cut-off points according to international definitions (Prado definition and later modified by Martin). Results: After analysing 190 patients, the prevalence of OS was 22.1% (42 patients), and sarcopenia was 13.7%. No statistically significant differences between body morphotypes were identified between sociodemographic and oncological characteristics. Regarding overall survival, multivariate analysis showed that pre-surgical body composition, specifically OS (Hazard Ratio 2.17 (1.3-3.6);p=0.002), was an independent prognostic factor. The impact of body composition on disease recurrence after GC gastrectomy was not identified. Logistic regression was performed to identify risk factors associated with postoperative complications. Age (p=0.002), ASA category III (p=0.047), and OS were identified as a risk factor for significant complications according to Clavien-Dindo classification ≥IIIb/IV [OR2.61 (1.04-6.6);p=0.041]. Conclusiones: • The prevalence of sarcopenic obesity in patients undergoing gastrectomy for gastric cancer was 22.1%. • Sarcopenic obesity was a risk factor for postoperative complications, doubling the risk of postoperative morbidity. • Post-surgical complications, doubling the risk of severe morbidity or grade ≥IIIb according to the Clavien-Dindo classification in patients with GC after gastrectomy. • Sarcopenic obesity was an independent prognostic factor for overall survival after gastrectomy. • Body composition, and in particular sarcopenic obesity, had no impact on disease-free survival in GC patients who underwent a gastrectomy.