Impact of Perioperative Immunonutrition on Postoperative Outcomes in Patients with Upper Gastrointestinal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

There is no consensus on the efficacy of perioperative immunonutrition in patients with upper gastrointestinal (GI) cancer surgery. We clarified the impact of perioperative immunonutrition on postoperative outcomes in patients with upper GI cancers. We searched MEDLINE (PubMed), MEDLINE (OVID), EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Selection, and Emcare from 1981-2022 using search terms related to immunonutrition and upper GI cancer. We included randomized controlled trials. Intervention was defined as immunonutritional therapy, including arginine, n-3 omega fatty acids, or glutamine during the perioperative period. The control was defined as standard nutritional therapy. The primary outcomes were infectious complications, defined as events with a Clavien-Dindo classification grade ≥ II that occurred within 30 days after surgery. After screening, 23 studies were included in the qualitative synthesis and in the quantitative synthesis. The meta-analysis showed that immunonutrition reduced infectious complications (relative risk ratio: 0.72; 95% confidence interval: 0.57-0.92; certainty of evidence: Moderate) compared with standard nutritional therapy. In conclusion, nutritional intervention with perioperative immunonutrition in patients with upper GI cancers significantly reduced infectious complications. The effect of immunonutrition for upper GI cancers in reducing the risk of infectious complications was about 30%.

Impact of Olfactory Change on Postoperative Body Weight Loss in Patients with Gastric Cancer after Gastrectomy.

Patients undergoing gastrectomy for gastric cancer may experience alterations in olfaction, yet the association between olfactory changes and postoperative weight loss remains uncertain. This study aimed to elucidate the relationship between olfactory changes and postoperative weight loss in patients with gastric cancer. Patients who underwent radical gastrectomy for gastric cancer between February 2022 and August 2022 were included in the study. Those experiencing a higher Visual Analog Scale (VAS) score postoperatively compared to preoperatively were deemed to have undergone olfactory changes. Postoperative weight loss was determined using the 75th percentile as a cutoff value, designating patients surpassing this threshold as experiencing significant weight loss. Multivariate logistic regression analysis was employed to identify risk factors for postoperative weight loss, with statistical significance set at p < 0.05. Out of 58 patients, 10 (17.2%) exhibited olfactory changes. The rate of postoperative weight loss at one month was markedly higher in the group with olfactory changes compared to those without (9.6% versus 6.2%, respectively; p = 0.002). In addition, the group experiencing olfactory changes demonstrated significantly lower energy intake compared to the group without such changes (1050 kcal versus 1250 kcal, respectively; p = 0.029). Logistic regression analysis revealed olfactory changes as an independent risk factor for significant weight loss at one month postoperatively (odds ratio: 7.64, 95% confidence interval: 1.09-71.85, p = 0.048). In conclusion, olfactory changes emerged as an independent risk factor for postoperative weight loss at one month in patients with gastric cancer following gastrectomy.

Impact of preoperative prealbumin levels on long-term prognosis in patients with gastric cancer after gastrectomy: a retrospective cohort study.

BACKGROUND: The relationship between preoperative prealbumin levels and long-term prognoses in patients with gastric cancer after gastrectomy has not been fully investigated. This study clarified the effect of preoperative prealbumin levels on the long-term prognosis of patients with gastric cancer after gastrectomy. METHODS: This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStage I-III gastric cancer and whose preoperative prealbumin levels were measured between May 2006 and March 2017. Participants were categorized according to their preoperative prealbumin levels into high (≥22 mg/dL), moderate (15-22 mg/dL), and low (<15 mg/dL) groups. The overall survival (OS) in the three groups was compared using the log-rank test, and prognostic factors were identified using Cox proportional hazards regression analysis. RESULTS: The median follow-up duration was 66 months. Of 4732 patients, 3649 (77.2%) were classified as high, 925 (19.6%) as moderate, and 158 (3.3%) as low. Lower prealbumin levels were associated with poorer prognoses (P < 0.001). Multivariate analysis showed that prealbumin levels of 15-22 mg/dL [hazard ratio (HR): 1.576, 95% confidence interval (CI): 1.353-1.835, P < 0.001] and <15 mg/dL (HR: 1.769, 95% CI: 1.376-2.276, P < 0.001) were independent poor prognostic factors for OS. When analyzed according to the cause of death, prealbumin levels were associated with other-cause survival, but not cancer-specific survival. CONCLUSIONS: Preoperative prealbumin levels correlated with OS in patients with gastric cancer after gastrectomy; the lower the prealbumin level, the worse is the prognosis. Prealbumin levels may be associated with other-cause survival.

Preoperative Chronic Inflammation Is a Risk Factor for Postoperative Complications Independent of Body Composition in Gastric Cancer Patients Undergoing Radical Gastrectomy.

The purpose of this study was to investigate the association between preoperative inflammation and postoperative complications in gastric cancer patients having elective gastrectomy. Participants in this study were those who underwent radical gastrectomy between April 2008 and June 2018 and were diagnosed with stage I-III primary gastric cancer. Preoperative CRP values were used to divide the patients into two groups: the inflammation group comprised individuals having a CRP level of ≥0.5 mg/dL; the other was the non-inflammation group. The primary outcome was overall complications of Clavien-Dindo grade II or higher after surgery. Using propensity score matching to adjust for background, we compared the postoperative outcomes of the groups and conducted a multivariate analysis to identify risk variables for complications. Of 951 patients, 852 (89.6%) were in the non-inflammation group and 99 (10.4%) were in the inflammation group. After matching, both groups included 99 patients, and no significant differences in patient characteristics were observed between both groups. The inflammation group had a significantly greater total number of postoperative complications (p = 0.019). The multivariate analysis revealed that a preoperative CRP level of ≥0.5 mg/dL was an independent risk factor for total postoperative complications in all patients (odds ratio: 2.310, 95% confidence interval: 1.430-3.730, p < 0.001). In conclusion, in patients undergoing curative resection for gastric cancer, preoperative inflammation has been found to be an independent risk factor for overall complications after surgery. Patients with chronic inflammation require preoperative treatment to reduce inflammation because chronic inflammation is the greatest risk factor for postoperative complications.

Impact of Perioperative Immunonutrition on Postoperative Outcomes for Patients Undergoing Head and Neck or Gastrointestinal Cancer Surgeries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To clarify whether perioperative immunonutrition is effective in adult patients with or without malnutrition undergoing elective surgery for head and neck (HAN) or gastrointestinal (GI) cancers. BACKGROUND: It is important to avoid postoperative complications in patients with cancer as they can compromise clinical outcomes. There is no consensus on the efficacy of perioperative immunonutrition in patients with or without malnutrition undergoing HAN or GI cancer surgery. MATERIALS AND METHODS: We searched MEDLINE (PubMed), MEDLINE (OVID), EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Selection, and Emcare from 1981 to 2022 using search terms related to immunonutrition and HAN or GI cancer. We included randomized controlled trials. Intervention was defined as immunonutritional therapy including arginine, n-3 omega fatty acids, or glutamine during the perioperative period. The control was defined as standard nutritional therapy. The primary outcomes were total postoperative and infectious complications, defined as events with a Clavien-Dindo classification grade ≥ II that occurred within 30 days after surgery. RESULTS: Of the 4825 patients from 48 included studies, 19 had upper GI cancer, 9 had lower, and 8 had mixed cancer, whereas 12 had HAN cancers. Immunonutrition reduced the total postoperative complications (relative risk ratio: 0.78; 95% CI, 0.66-0.93; certainty of evidence: high) and infectious complications (relative risk ratio: 0.71; 95% CI, 0.61-0.82; certainty of evidence: high) compared with standard nutritional therapy. CONCLUSIONS: Nutritional intervention with perioperative immunonutrition in patients with HAN and GI cancers significantly reduced total postoperative complications and infectious complications.

Diagnosis of carpal tunnel syndrome using a 10-s grip-and-release test with video and machine learning analysis.

We developed a finger motion-based diagnostic system for carpal tunnel syndrome by analysing 10 second grip-and-release test videos. Using machine learning, it estimated presence of carpal tunnel syndrome (89% sensitivity and 83% specificity) and correlated with severity on nerve conduction studies (coefficient 0.68). LEVEL OF EVIDENCE: III.

Impact of Preoperative Nutritional Assessment on Other-Cause Survival after Gastrectomy in Patients with Gastric Cancer.

This study aimed to clarify the factors associated with death due to other diseases after a gastrectomy for gastric cancer. This retrospective cohort study included consecutive patients who had undergone gastrectomy between April 2008 and June 2018 for primary stage II-III gastric cancer. The primary outcome was other-cause survival. To identify prognostic factors for other-cause survival for univariate analysis, we used a Cox proportional hazard regression model. A total of 512 patients met the inclusion criteria. The average age was 67.93 years, and the average body mass index was 22.75 kg/m2, with 84 (16.4%) being moderately malnourished and 88 (17.2%) being severely malnourished, as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria. The other-cause survival for the malnourished group was significantly worse than that for the normal group (p < 0.001). The prognosis was worse when the severity of malnutrition was worse (p < 0.001). Multivariate analysis showed that severe malnutrition was significantly independent of prognostic factors for other-cause survival (hazard ratio: 3.310; 95% confidence interval: 1.426-7.682; p = 0.005). Undernutrition, as defined by the GLIM criteria, is useful for the preoperative prediction of death due to other diseases after gastrectomy in patients with advanced gastric cancer.

Impact of laparoscopic gastrectomy on long-term prognosis of patients with primary T3 or more advanced gastric cancer: A propensity score matching analysis.

Background: There is no consensus regarding a better long-term prognosis with laparoscopic gastrectomy than with open surgery in patients with advanced gastric cancer, especially in patients with T3 or more advanced gastric cancer. We investigated the impact of laparoscopic gastrectomy on the long-term prognosis of patients who underwent radical gastrectomy for primary T3 or more advanced gastric cancer. Methods: This single-center, retrospective cohort study included 294 consecutive patients who underwent radical gastrectomy for primary T3 or more advanced gastric cancer from April 2008 through April 2017. We compared overall survival between laparoscopic and open surgery, using propensity score matching to adjust for baseline characteristics. We also investigated prognostic factors for overall survival by a forward stepwise procedure of Cox proportional hazards regression for multivariate analysis. Results: There were 136 (46.3%) and 158 (53.7%) patients in the laparoscopy and open groups, respectively. The median follow-up period was 39 mo. After matching, there were 97 patients in each group, with no significant differences in background characteristics. After matching, the overall survival was significantly worse in the open group than in the laparoscopy group (P < 0.001). Multivariate analyses also showed that open surgery was an independent poor prognostic factor for overall survival (hazard ratio: 2.160, 95% concordance interval: 1.365-3.419, P = 0.001). Conclusion: Overall survival may be better with laparoscopic gastrectomy than with open surgery for patients with primary T3 or more advanced gastric cancer.

Screening for degenerative cervical myelopathy with the 10-second grip-and-release test using a smartphone and machine learning: A pilot study.

Objective: Early detection and intervention are essential for the mitigation of degenerative cervical myelopathy (DCM). However, although several screening methods exist, they are difficult to understand for community-dwelling people, and the equipment required to set up the test environment is expensive. This study investigated the viability of a DCM-screening method based on the 10-second grip-and-release test using a machine learning algorithm and a smartphone equipped with a camera to facilitate a simple screening system. Methods: Twenty-two participants comprising a group of DCM patients and 17 comprising a control group participated in this study. A spine surgeon diagnosed the presence of DCM. Patients performing the 10-second grip-and-release test were filmed, and the videos were analyzed. The probability of the presence of DCM was estimated using a support vector machine algorithm, and sensitivity, specificity, and area under the curve (AUC) were calculated. Two assessments of the correlation between estimated scores were conducted. The first used a random forest regression model and the Japanese Orthopaedic Association scores for cervical myelopathy (C-JOA). The second assessment used a different model, random forest regression, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: The final classification model had a sensitivity of 90.9%, specificity of 88.2%, and AUC of 0.93. The correlations between each estimated score and the C-JOA and DASH scores were 0.79 and 0.67, respectively. Conclusions: The proposed model could be a helpful screening tool for DCM as it showed excellent performance and high usability for community-dwelling people and non-spine surgeons.

Relationship between antithrombotic drugs and postoperative outcomes in patients with gastric cancer after gastrectomy: a propensity matching analysis.

BACKGROUND: As there is no consensus on the impact of antithrombotic drugs on post-gastrectomy outcomes in gastric cancer patients, this study aimed to investigate the impact of antithrombotic drugs on postoperative outcomes in these patients after gastrectomy. METHODS: Patients with Stage I-III primary gastric cancer who underwent radical gastrectomy between April 2005 and May 2022 were included. We performed propensity score matching to adjust for patient background and compared bleeding complications. Multivariate analysis with logistic regression analysis was performed to identify risk factors associated with bleeding complications. RESULTS: Of the 6798 patients, 310 (4.6%) were in the antithrombotic group and 6488 (95.4%) were in the non-antithrombotic group. Twenty-six patients (0.38%) experienced bleeding complications. After matching, the number of patients in each group was 300, with insignificant differences in any factor. A comparison of postoperative outcomes showed no difference in bleeding complications (P = 0.249). In the antithrombotic group, 39 (12.6%) continued drugs, and 271 (87.4%) discontinued them before surgery. After matching, there were 30 and 60 patients, respectively, with no differences in patient background. A comparison of postoperative outcomes showed no differences in bleeding complications (P = 0.551). In multivariate analysis, antithrombotic drug use and continuation of antiplatelet agents were not risk factors for bleeding complications. CONCLUSION: Antithrombotic drugs and its continuation may not worsen bleeding complications in patients with gastric cancer after radical gastrectomy. Bleeding complications were rare, and further studies are needed on risk factors for bleeding complications in larger databases.

Impact of Sex-Specific Preoperative Fat Mass Assessment on Long-Term Prognosis after Gastrectomy for Gastric Cancer.

We investigated the impact of the difference in fat distribution between men and women on long-term prognosis after gastrectomy in patients with advanced gastric cancer. Patients with advanced gastric cancer deeper than p-T2 who underwent gastrectomy between April 2008 and June 2018 were included. Visceral fat mass index (VFI) and subcutaneous fat mass index (SFI) were calculated by dividing the cross-sectional area at the umbilical level by the height squared. The medians of VFI and SFI by sex were defined as cut-off values, below which values were defined as low VFI and low SFI. Of the 485 patients, 323 (66.6%) were men and 162 (33.4%) were women. Men with a low VFI had a significantly worse overall survival (OS) (p = 0.004) and women with a low SFI had a significantly worse OS (p = 0.007). Patients with a low VFI and low SFI had the worst prognosis. Multivariate analysis showed that a low VFI was an independent poor prognostic factor in men, while a low SFI was an independent poor prognostic factor in women. In conclusion, a low visceral fat mass in men and a low subcutaneous fat mass in women were independent poor prognostic factors after radical gastrectomy for advanced gastric cancer.

Impact of malnutrition as defined by the GLIM criteria on treatment outcomes in patients with cancer: A systematic review and meta-analysis.

BACKGROUND & AIMS: Malnutrition has been reported to lead to poor postoperative outcomes. The Global Leadership Initiative on Malnutrition (GLIM) criteria were published in 2019 as a global consensus on the criteria for diagnosing malnutrition. However, the relationship between GLIM-defined malnutrition and treatment outcomes in patients with cancer has not been fully investigated. Therefore, this study aimed to clarify the impact of GLIM-defined malnutrition on the treatment outcomes of patients with cancer. METHODS: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov and identified observational studies published from inception to January 17, 2022. We conducted a systematic review and random-effects meta-analysis studies that included patients with cancer aged >18 years who received any kind of treatment and whose nutritional status was assessed using GLIM criteria. We independently assessed the risk of bias and quality of evidence using Quality In Prognosis Studies and Grading of Recommendations, Assessment, Development, and Evaluation approach. The primary outcomes were overall survival (OS) and postoperative complications. Hazard ratios and 95% confidence intervals (CIs) for OS and relative risk ratios and 95% CIs for postoperative complications were pooled. The protocol was published by PROSPERO (CRD42022304004). RESULTS: Of 67 studies after screening, ten studies (n = 11,700) reported the impact of GLIM-defined malnutrition on postoperative outcomes. Compared with no malnutrition, GLIM-defined malnutrition may worsen OS (hazard ratio, 1.56; 95% CI, 1.38-1.75; I2 = 37%) and increase postoperative complications (relative risk ratio, 1.82; 95% CI, 1.28-2.60; I2 = 87%). The risk of bias in each study was either moderate or high. The certainty of the evidence was low because of publication bias and a moderate or high risk of bias. CONCLUSIONS: GLIM-defined malnutrition may worsen OS and increase the risk of postoperative complications in patients with cancer undergoing treatment. Further studies are needed to confirm these findings and mitigate this risk.

Association of GLIM Defined Malnutrition According to Preoperative Chronic Inflammation with Long-Term Prognosis after Gastrectomy in Patients with Advanced Gastric Cancer.

This study aimed to investigate the association of malnutrition, defined by the Global Leadership Initiative on Malnutrition (GLIM) according to preoperative chronic inflammation with long-term prognosis after gastrectomy in patients with advanced gastric cancer. We included patients with primary stage I-III gastric cancer who underwent gastrectomy between April 2008 and June 2018. Patients were categorized as normal, moderate malnutrition, and severe malnutrition. Preoperative chronic inflammation was defined as a C-reactive protein level of >0.5 mg/dL. The primary endpoint was overall survival (OS), compared between the inflammation and non-inflammation groups. Among the 457 patients, 74 (16.2%) and 383 (83.8%) were included in the inflammation and non-inflammation groups, respectively. The prevalence of malnutrition was similar in both groups (p = 0.208). Multivariate analyses for OS showed that moderate malnutrition (hazard ratios: 1.749, 95% concordance interval: 1.037-2.949, p = 0.036) and severe malnutrition (hazard ratios: 1.971, 95% CI: 1.130-3.439, p = 0.017) were poor prognostic factors in the non-inflammation group, but malnutrition was not a prognostic factor in the inflammation group. In conclusion, preoperative malnutrition was a poor prognostic factor in patients without inflammation, but it was not a prognostic factor in patients with inflammation.

Effect of malnutrition as defined by the Global Leadership Initiative on Malnutrition criteria on compliance of adjuvant chemotherapy and relapse-free survival for advanced gastric cancer.

OBJECTIVES: The aim of the present study was to clarify the effect of malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria on compliance with postoperative adjuvant chemotherapy and relapse-free survival (RFS) in patients with gastric cancer. METHODS: This single-center, retrospective cohort study included 281 consecutive patients with gastric cancer who underwent radical gastrectomy for pathologic stages II and III and received postoperative S-1 adjuvant chemotherapy between April 2008 and June 2018. Treatment failure was defined as discontinuation of adjuvant chemotherapy ≤1 y. Nutritional assessment was preoperatively performed according to the GLIM criteria for all patients. We analyzed risk factors for treatment failure and poor prognostic factors for RFS using multivariate analyses. RESULTS: Treatment failure and recurrence were observed in 50 (17.8%) and 97 (34.5%) of the 281 patients, respectively. The median follow-up period was 52 mo. The treatment failure rate was higher (P = 0.032) and RFS was worse (P = 0.017) in the malnutrition group. In multivariate analyses, GLIM criteria-defined malnutrition was an independent risk factor for treatment failure (odds ratio = 3.110; 95% confidence interval [CI], 1.020-9.470; P = 0.046). Furthermore, severe malnutrition was an independent poor prognostic factor for RFS (hazard ratio = 1.767; 95% CI, 1.132-2.759; P = 0.012). CONCLUSIONS: Preoperative malnutrition as defined by the GLIM criteria was an independent risk factor for poor compliance with adjuvant S-1 chemotherapy and a poor prognostic factor for RFS after radical gastrectomy in patients with advanced gastric cancer.

Current status of the association between malnutrition defined by the GLIM criteria and postoperative outcomes in gastrointestinal surgery for cancer: a narrative review.

In 2018, the Global Leadership Initiative on Malnutrition consortium published global consensus diagnostic criteria for malnutrition and highlighted the association between malnutrition and poor postoperative outcomes in patients with gastrointestinal cancer. The aforementioned criteria consist of phenotypic and etiologic criteria to diagnose malnutrition in individuals who undergo conventional screening to determine the at-risk population. Recent studies have reported the usefulness of prediction of postoperative outcomes using body mass index, weight loss, and reduced muscle mass as phenotypic criteria. Reduced muscle mass is an essential diagnostic criterion for sarcopenia, which is associated with poor outcomes in patients with cancer. The Global Leadership Initiative on Malnutrition criteria define reduced muscle mass as undernutrition. Malnutrition diagnosed based on the Global Leadership Initiative on Malnutrition criteria is an important risk factor for postoperative complications and also an independent poor prognostic factor for long-term outcomes; greater severity of malnutrition is associated with poorer outcomes. The current Global Leadership Initiative on Malnutrition criteria for malnutrition accurately predict outcomes, including postoperative complications and long-term prognosis; however, a revision may be warranted to ensure consistency with the diagnostic criteria for sarcopenia. Patients diagnosed with malnutrition based on the Global Leadership Initiative on Malnutrition criteria should be targeted for nutritional intervention. Further accumulation of evidence is necessary to conclusively establish the role of nutritional interventions in patients with malnutrition to improve postoperative complications and long-term outcomes.

Impact of malnutrition as defined by the global leadership initiative on malnutrition criteria on the long-term prognosis in older patients with gastric cancer after gastrectomy.

PURPOSE: This study investigated whether or not the impact of malnutrition, as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria, on the long-term prognosis after gastrectomy differed between older and young patients with advanced gastric cancer. METHODS: This study included patients with primary stage I-III gastric cancer who underwent gastrectomy between April 2008 and June 2018. Patients were divided into normal, moderate, and severe malnutrition groups according to the GLIM criteria for the body mass index (BMI) and body weight loss (BWL). The primary endpoint was the overall survival (OS). RESULTS: Of the 512 patients, 274 (53.5%) were included in the younger group (< 70 years old) and 238 (46.5%) in the older group (≥ 70 years old). The prevalence of moderate and severe malnutrition was significantly higher in the older group than in the younger group (P < 0.001 and P = 0.001, respectively). A multivariate analysis showed that moderate malnutrition [hazard ratio (HR) 1.793, P = 0.028] and severe malnutrition (HR 2.374, P = 0.002) were independent prognostic factors in the older group but not in the younger group. CONCLUSION: GLIM criteria-defined malnutrition did not correlate with the prognosis in the younger group, whereas moderate and severe malnutrition were independent poor prognostic factors for the OS in the older group.

Impact of Preoperative Handgrip Strength on Postoperative Outcome after Radical Gastrectomy for Gastric Cancer Patients.

In this study, we investigated whether preoperative low-handgrip strength (HGS) defined by the Asian working group for sarcopenia could be a predictor of postoperative outcomes in patients with gastric cancer. A total of 327 patients who underwent radical gastrectomy for c-stage I-III primary gastric cancer with pre-operative HGS records were included. The cut-off values of HGS were defined as 28 kg for males and 18 kg for females, with values below and above the cut-off defined as low-HGS and high-HGS, respectively. The primary outcome was infectious complications. We compared the postoperative outcomes of the groups after adjusting for the background using propensity score matching. Of the 327 patients, 246 (75.2%) and 81 (24.8%) were in the high and low-HGS groups, respectively. After adjusting for background, there were 57 patients in both groups. After matching, the low-HGS group had significantly more infectious complications (17.5% vs. 1.8%, p = 0.008). Multivariate analysis of infectious complications in the low-HGS group demonstrated chronic kidney disease and diabetes as independent risk factors (odds ratio 4.390, 95% confidence interval 1.120-17.20, p = 0.034). Preoperative low-HGS according to the Asian criteria was associated with infectious complications after gastrectomy. Chronic kidney disease and diabetes were independent risk factors for infectious complications among patients with low-HGS.

Preoperative High Visceral Fat Increases Severe Complications but Improves Long-Term Prognosis after Gastrectomy for Patients with Advanced Gastric Cancer: A Propensity Score Matching Analysis.

This study investigated the paradox of high visceral fat mass increasing severe complications but improving long-term prognosis after radical gastrectomy for gastric cancer. This was a retrospective cohort study of consecutive patients with primary stage I-III gastric cancer who underwent gastrectomy between April 2008 and June 2018. The visceral adipose tissue index (VAI) was calculated by dividing the visceral fat mass preoperatively measured on computed tomography by the square of the height. Patients with VAIs below the median cut-off value were classified as low-VAI, while those above it were classified as high-VAI. We compared the postoperative complication rate and overall survival (OS) in the low- and high-VAI groups after adjusting patient characteristics using propensity score matching (PSM). There were 155 patients in both groups after PSM. After matching, there was no significant difference in factors other than BMI and VAI that were not adjusted. The high-VAI group had more severe postoperative complications (p = 0.018), but the OS was significantly better in the high-VAI group (hazard ratio 0.611, 95%CI 0.403-0.928, p = 0.021). Preoperative high visceral fat mass not only increased severe complications, but also improved OS after gastrectomy in patients with advanced gastric cancer.

Relationship Between Fat Mass Indices and Postoperative Complications After Laparoscopic Gastrectomy in Patients With Gastric Cancer: A Propensity Score Matching Analysis.

BACKGROUND/AIM: Visceral adipose tissue index (VAI) and visceral-to-subcutaneous adipose tissue area ratio (VSR) are indices related to visceral fat mass, and intramuscular adipose tissue content (IMAC) is an index related to intramuscular fat. We investigated the impact of fat mass-related indices on the incidence of postoperative complications. PATIENTS AND METHODS: Patients who underwent radical laparoscopic gastrectomy for c-stage I primary gastric cancer between April 2014 and December 2020 were included. We investigated the relationship between both VAI, VSR, IMAC and postoperative complications. For each value, the median was used as a cut-off point, the patients were divided into high- and low-fat groups, and background adjustments using propensity score matching analysis were used to compare these two groups. RESULTS: Of the 490 patients, 245 (50.0%) were in the high-VAI group, 243 (49.6%) in the high-VSR group, and 239 (48.8%) in the high-IMAC group. After matching, intra-abdominal abscess and pancreatic fistula were greater in the high-VAI group than those in the low-VAI group (p=0.081 and p=0.081, respectively), and were also significantly greater in the high-VSR group (p=0.012 and p=0.025, respectively). However, anastomotic leakage was greater in the high-IMAC group than in the low-IMAC group (p=0.050). CONCLUSION: VAI and VSR, which reflect visceral fat mass, were useful in predicting intra-abdominal infections, whereas IMAC, which reflects intramuscular fat, was useful in predicting anastomotic leakage. Preoperative prediction using a combination of these factors may aid clinical assessment of complication risk.