SARCOPENIA IN GASTRIC CANCER AND BODY COMPOSITION CHANGES AFTER GASTRECTOMY
Abstract
Sarcopenia is the phenomenon of loss of muscle strength, muscle performance and muscle mass due to either age (primary sarcopenia) or other illnesses such as cancer (secondary sarcopenia). Sarcopenia has often been defined in the literature as low muscle mass. Sarcopenia among gastric cancer patients has been shown to carry a higher risk of post-operative complications and a higher overall and disease-specific mortality. Our study included 86 patients who underwent surgery for gastric cancer at our institution. Muscle mass was assessed by CT scan (L3 Muscle Index). A subgroup analysis was then performed of 39 patients who had had CT scans 12 months postoperatively. We collected demographic, clinical and body composition data. Sarcopenia was defined by the L3 Muscle Mass Index according to cut-off values previously defined in the literature. We found a prevalence of sarcopenia of 40.7% among gastric cancer patients undergoing gastrectomy. Sarcopenia was associated with a higher overall mortality. Nutritional risk and percentage of body weight lost did not identify sarcopenic patients. 51.4% of sarcopenic patients were overweight, 2.9% were obese. At 12 months post-operatively, 82.1% of patients lost weight and BMI and 76.9% of patients lost muscle mass (lower L3 muscle index) after gastrectomy. We did not find a significant association between the change in muscle mass, BMI or weight. We found that total gastrectomy was significantly associated to muscle mass loss compared to subtotal gastrectomy. We also found a significant association between advanced gastric cancer stage and muscle mass loss. We concluded that while sarcopenia is highly prevalent among gastric cancer patients after gastrectomy, the vast majority of patients lose weight and muscle mass. Since most patients will not improve muscle mass postoperatively it is crucial to implement prehabilitation strategies early on.
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References
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13. Wang S-L, Zhuang C-L, Huang D-D, Pang W-Y, Lou N, Chen F-F, et al. Sarcopenia Adversely Impacts Postoperative Clinical Outcomes Following Gastrectomy in Patients with Gastric Cancer: A Prospective Study. Ann Surg Oncol. 2016 Feb;23(2):556–64.
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17. Lu J, Zheng Z-F, Li P, Xie J-W, Wang J-B, Lin J-X, et al. A Novel Preoperative Skeletal Muscle Measure as a Predictor of Postoperative Complications, Long-Term Survival and Tumor Recurrence for Patients with Gastric Cancer After Radical Gastrectomy. Ann Surg Oncol. 2018 Feb;25(2):439–48.
18. O’Brien S, Kavanagh RG, Carey BW, Maher MM, O’Connor OJ, Andrews EJ. The impact of sarcopenia and myosteatosis on postoperative outcomes in patients with inflammatory bowel disease. Eur Radiol Exp. 2018 Nov 21;2(1):37.
19. Zhuang C-L, Huang D-D, Pang W-Y, Zhou C-J, Wang S-L, Lou N, et al. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer: Analysis from a Large-Scale Cohort. Medicine. 2016 Mar;95(13):e3164.
20. Sakurai K, Kubo N, Tamura T, Toyokawa T, Amano R, Tanaka H, et al. Adverse Effects of Low Preoperative Skeletal Muscle Mass in Patients Undergoing Gastrectomy for Gastric Cancer. Ann Surg Oncol. 2017 Sep;24(9):2712–9.
21. Martin L, Birdsell L, MacDonald N, Reiman T, Clandinin MT, McCargar LJ, et al. Cancer Cachexia in the Age of Obesity: Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index. JCO. 2013 Apr 20;31(12):1539–47.
22. Nishigori T, Obama K, Sakai Y. Assessment of body composition and impact of sarcopenia and sarcopenic obesity in patients with gastric cancer. Transl Gastroenterol Hepatol. 2020 Apr;5:22–22.
23. Kouzu K, Tsujimoto H, Sugasawa H, Ishibashi Y, Itazaki Y, Tsuchiya S, et al. Impact of postoperative reduced skeletal muscle on prognosis after recurrence in gastric cancer. Mol Clin Oncol. 2020 Oct 30;14(1):1–1.
24. Moisey LL, Mourtzakis M, Cotton BA, Premji T, Heyland DK, Wade CE, et al. Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care.2013 Sep 19;17(5):R206.
25. Choi Y, Oh D-Y, Kim T-Y, Lee K-H, Han S-W, Im S-A, et al. Skeletal Muscle Depletion Predicts the Prognosis of Patients with Advanced Pancreatic Cancer Undergoing Palliative Chemotherapy, Independent of Body Mass Index. PLOS ONE. 2015 Oct 5;10(10):e0139749.
26. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012 Sep 4;107(6):931-6.
27. Schaap LA, van Schoor NM, Lips P, Visser M. Associations of Sarcopenia Definitions, and Their Components, With the Incidence of Recurrent Falling and Fractures: The Longitudinal Aging Study Amsterdam. The Journals of Gerontology: Series A. 2018 Aug 10;73(9):1199–204.
28. Schaap LA, Koster A, Visser M. Adiposity, Muscle Mass, and Muscle Strength in Relation to Functional Decline in Older Persons. Epidemiologic Reviews. 2013;35(1):51–65.
29. Derstine BA, Holcombe SA, Ross BE, Wang NC, Su GL, Wang SC. Optimal body size adjustment of L3 CT skeletal muscle area for sarcopenia assessment. Sci Rep. 2021 Dec;11(1):279.
30. Prado CMM, Heymsfield SB. Lean Tissue Imaging: A New Era for Nutritional Assessment and Intervention. JPEN J Parenter Enteral Nutr. 2014 Nov;38(8):940–53.
31. Baracos V, Kazemi-Bajestani SMR. Clinical outcomes related to muscle mass in humans with cancer and catabolic illnesses. The International Journal of Biochemistry & Cell Biology. 2013 Oct;45(10):2302–8.
32. Su H, Ruan J, Chen T, Lin E, Shi L. CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis. Cancer Imaging. 2019 Dec;19(1):82.
33. Park HS. Marked Loss of Muscle, Visceral Fat, or Subcutaneous Fat After Gastrectomy Predicts Poor Survival in Advanced Gastric Cancer: Single-Center Study from the CLASSIC Trial. Ann Surg Oncol. 2018 Oct;25(11):3222-3230.
34. Mosk CA, van Vugt JLA, de Jonge H, Witjes CD, Buettner S, Ijzermans JN, van der Laan L. Low skeletal muscle mass as a risk factor for postoperative delirium in elderly patients undergoing colorectal cancer surgery. Clin Interv Aging. 2018 Oct 24;13:2097-2106.
35. Palmela C, Velho S, Agostinho L, Branco F, Santos M, Santos MPC, et al. Body Composition as a Prognostic Factor of Neoadjuvant Chemotherapy Toxicity and Outcome in Patients with Locally Advanced Gastric Cancer. J Gastric Cancer. 2017;17(1):74.
36. Kudou K, Saeki H, Nakashima Y, Edahiro K, Korehisa S, Taniguchi D, Tsutsumi R, Nishimura S, Nakaji Y, Akiyama S, Tajiri H, Nakanishi R, Kurashige J, Sugiyama M, Oki E, Maehara Y. Prognostic Significance of Sarcopenia in Patients with Esophagogastric Junction Cancer or Upper Gastric Cancer. Ann Surg Oncol. 2017 Jul;24(7):1804-1810.
37. Faron A, Sprinkart AM, Kuetting DLR, Feisst A, Isaak A, Endler C, et al. Body composition analysis using CT and MRI: intra- individual intermodal comparison of muscle mass and myosteatosis. Sci Rep. 2020 Dec;10(1):11765.
38. Lee CM, Kang J. Prognostic impact of myosteatosis in patients with colorectal cancer: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2020 Oct;11(5):1270-1282.
39. Srpcic M, Jordan T, Popuri K, Sok M. Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer. Radiol Oncol. 2020 Mar 27;54(2):237-246.
40. Zhuang C-L, Shen X, Huang Y-Y, Zhang F-M, Chen X-Y, Ma L-L, et al. Myosteatosis predicts prognosis after radical gastrectomy for gastric cancer: A propensity score–matched analysis from a large-scale cohort. Surgery. 2019 Sep;166(3):297–304.
41. Zheng, Z.F.; Lu, J.; Zheng, C.H.; Li, P.; Xie, J.W.; Wang, J.B.; Lin, J.X.; Chen, Q.Y.; Lin, M.; Huang, C.M.; et al. A Novel Prognostic Scoring System Based on Preoperative Sarcopenia Predicts the Long-Term Outcome for Patients After R0 Resection for Gastric Cancer: Experiences of a High-Volume Center. Ann. Surg. Oncol. 2017, 24, 1795–1803.
42. Kamarajah SK, Bundred J, Tan BHL. Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis. Gastric Cancer. 2019 Jan;22(1):10–22.
43. Rodrigues V. Is Sarcopenic Obesity an Indicator of Poor Prognosis in Gastric Cancer Surgery? A Cohort Study in a Western Population. J Gastrointest Surg. :16.
44. Takahashi S, Shimizu S, Nagai S, Watanabe H, Nishitani Y, Kurisu Y. Characteristics of sarcopenia after distal gastrectomy in elderly patients. Mogi M, editor. PLoS ONE. 2019 Sep 11;14(9):e0222412.
45. Lee K, Kim KW, Lee J-B, Shin Y, Jang JK, Yook J-H, et al. Impact of remnant stomach volume and anastomosis on nutrition and body composition in gastric cancer patients. Surg Oncol. 2019 Dec;31:75-82.
46. Kugimiya N, Harada E, Oka K, Kawamura D, Suehiro Y, Takemoto Y, et al. Loss of skeletal muscle mass after curative gastrectomy is a poor prognostic factor. Oncol Lett. 2018 Jul;16(1):1341-1347.
47. Park SE, Choi JH, Park JY, Kim BJ, Kim JG, Kim JW, Park JM, Chi KC, Hwang IG. Loss of skeletal muscle mass during palliative chemotherapy is a poor prognostic factor in patients with advanced gastric cancer. Sci Rep. 2020 Oct 19;10(1):17683.
48. Shen Y, Hao Q, Zhou J, Dong B. The impact of frailty and sarcopenia on postoperative outcomes in older patients undergoing gastrectomy surgery: a systematic review and meta-analysis. BMC Geriatr. 2017 Dec;17(1):188.
49. Zanetti M, Gortan Cappellari G, Barazzoni R, Sanson G. The Impact of Protein Supplementation Targeted at Improving Muscle Mass on Strength in Cancer Patients: A Scoping Review. Nutrients. 2020 Jul 16;12(7):2099.
50. Prado CM, Purcell SA, Laviano A. Nutrition interventions to treat low muscle mass in cancer. J Cachexia Sarcopenia Muscle. 2020 Apr;11(2):366–80.
51. Steffl M, Bohannon RW, Sontakova L, Tufano JJ, Shiells K, Holmerova I. Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis. Clin Interv Aging. 2017 May 17;12:835-845.
52. Molenaar CJL, Papen-Botterhuis NE, Herrle F, Slooter GD. Prehabilitation, making patients fit for surgery – a new frontier in perioperative care. Innovative Surgical Sciences. 2019 Dec 18;4(4):132–8.
2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and Ageing. 2010 Jul 1;39(4):412–23.
3. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 2019 Jan 1;48(1):16–31.
4. Borggreve AS, den Boer RB, van Boxel GI, de Jong PA, Veldhuis WB, Steenhagen E, et al. The Predictive Value of Low Muscle Mass as Measured on CT Scans for Postoperative Complications and Mortality in Gastric Cancer Patients: A Systematic Review and Meta-Analysis. JCM. 2020 Jan 11;9(1):199.
5. Tegels JJW, van Vugt JLA, Reisinger KW, Hulsewé KWE, Hoofwijk AGM, Derikx JPM, et al. Sarcopenia is highly prevalent in patients undergoing surgery for gastric cancer but not associated with worse outcomes: Sarcopenia Prevalent in Gastric Cancer. J Surg Oncol. 2015 Aug;112(4):403–7.
6. Mirkin KA, Luke FE, Gangi A, Pimiento JM, Jeong D, Hollenbeak CS, et al. Sarcopenia related to neoadjuvant chemotherapy and perioperative outcomes in resected gastric cancer: a multi-institutional analysis. J Gastrointest Oncol. 2017 Jun;8(3):589–95.
7. Huang D-D, Cai H-Y, Chen X-Y, Dong W-X, Wangchuk D, Yan J-Y, et al. Value of Sarcopenia defined by the new EWGSOP2 consensus for the prediction of Postoperative Complications and Long-term Survival after Radical Gastrectomy for Gastric Cancer: A comparison with four common nutritional screening tools. J Cancer. 2020;11(19):5852–60.
8. Huang D-D, Chen X-X, Chen X-Y, Wang S-L, Shen X, Chen X-L, et al. Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study. J Cancer Res Clin Oncol. 2016 Nov;142(11):2347–56.
9. Huang D-D, Zhou C-J, Wang S-L, Mao S-T, Zhou X-Y, Lou N, et al. Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer. Surgery. 2017 Mar;161(3):680–93.
10. Kudou K, Saeki H, Nakashima Y, Edahiro K, Korehisa S, Taniguchi D, et al. Prognostic Significance of Sarcopenia in Patients with Esophagogastric Junction Cancer or Upper Gastric Cancer. Ann Surg Oncol. 2017 Jul;24(7):1804-1810.
11. Nishigori T, Tsunoda S, Okabe H, Tanaka E, Hisamori S, Hosogi H, et al. Impact of Sarcopenic Obesity on Surgical Site Infection after Laparoscopic Total Gastrectomy. Ann Surg Oncol. 2016 Aug;23(S4):524–31.
12. Zhang Y, Wang JP, Wang XL, Tian H, Gao TT, Tang LM, et al. Computed tomography–quantified body composition predicts short-term outcomes after gastrectomy in gastric cancer. Curr Oncol. 2018 Nov 2;25(5).
13. Wang S-L, Zhuang C-L, Huang D-D, Pang W-Y, Lou N, Chen F-F, et al. Sarcopenia Adversely Impacts Postoperative Clinical Outcomes Following Gastrectomy in Patients with Gastric Cancer: A Prospective Study. Ann Surg Oncol. 2016 Feb;23(2):556–64.
14. Sierzega, M, Chrzan, R, Wiktorowicz, M, Kolodziejczyk, P, Richter, P. Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach. J Surg Oncol. 2019; 120: 473‐ 482.
15. Nishigori T, Tsunoda S, Obama K, Hisamori S, Hashimoto K, Itatani Y, et al. Optimal Cutoff Values of Skeletal Muscle Index to Define Sarcopenia for Prediction of Survival in Patients with Advanced Gastric Cancer. Ann Surg Oncol. 2018 Nov;25(12):3596–603.
16. Kuwada K, Kuroda S, Kikuchi S, Yoshida R, Nishizaki M, Kagawa S, et al. Sarcopenia and Comorbidity in Gastric Cancer Surgery as a Useful Combined Factor to Predict Eventual Death from Other Causes. Ann Surg Oncol. 2018 May;25(5):1160–6.
17. Lu J, Zheng Z-F, Li P, Xie J-W, Wang J-B, Lin J-X, et al. A Novel Preoperative Skeletal Muscle Measure as a Predictor of Postoperative Complications, Long-Term Survival and Tumor Recurrence for Patients with Gastric Cancer After Radical Gastrectomy. Ann Surg Oncol. 2018 Feb;25(2):439–48.
18. O’Brien S, Kavanagh RG, Carey BW, Maher MM, O’Connor OJ, Andrews EJ. The impact of sarcopenia and myosteatosis on postoperative outcomes in patients with inflammatory bowel disease. Eur Radiol Exp. 2018 Nov 21;2(1):37.
19. Zhuang C-L, Huang D-D, Pang W-Y, Zhou C-J, Wang S-L, Lou N, et al. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer: Analysis from a Large-Scale Cohort. Medicine. 2016 Mar;95(13):e3164.
20. Sakurai K, Kubo N, Tamura T, Toyokawa T, Amano R, Tanaka H, et al. Adverse Effects of Low Preoperative Skeletal Muscle Mass in Patients Undergoing Gastrectomy for Gastric Cancer. Ann Surg Oncol. 2017 Sep;24(9):2712–9.
21. Martin L, Birdsell L, MacDonald N, Reiman T, Clandinin MT, McCargar LJ, et al. Cancer Cachexia in the Age of Obesity: Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index. JCO. 2013 Apr 20;31(12):1539–47.
22. Nishigori T, Obama K, Sakai Y. Assessment of body composition and impact of sarcopenia and sarcopenic obesity in patients with gastric cancer. Transl Gastroenterol Hepatol. 2020 Apr;5:22–22.
23. Kouzu K, Tsujimoto H, Sugasawa H, Ishibashi Y, Itazaki Y, Tsuchiya S, et al. Impact of postoperative reduced skeletal muscle on prognosis after recurrence in gastric cancer. Mol Clin Oncol. 2020 Oct 30;14(1):1–1.
24. Moisey LL, Mourtzakis M, Cotton BA, Premji T, Heyland DK, Wade CE, et al. Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care.2013 Sep 19;17(5):R206.
25. Choi Y, Oh D-Y, Kim T-Y, Lee K-H, Han S-W, Im S-A, et al. Skeletal Muscle Depletion Predicts the Prognosis of Patients with Advanced Pancreatic Cancer Undergoing Palliative Chemotherapy, Independent of Body Mass Index. PLOS ONE. 2015 Oct 5;10(10):e0139749.
26. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012 Sep 4;107(6):931-6.
27. Schaap LA, van Schoor NM, Lips P, Visser M. Associations of Sarcopenia Definitions, and Their Components, With the Incidence of Recurrent Falling and Fractures: The Longitudinal Aging Study Amsterdam. The Journals of Gerontology: Series A. 2018 Aug 10;73(9):1199–204.
28. Schaap LA, Koster A, Visser M. Adiposity, Muscle Mass, and Muscle Strength in Relation to Functional Decline in Older Persons. Epidemiologic Reviews. 2013;35(1):51–65.
29. Derstine BA, Holcombe SA, Ross BE, Wang NC, Su GL, Wang SC. Optimal body size adjustment of L3 CT skeletal muscle area for sarcopenia assessment. Sci Rep. 2021 Dec;11(1):279.
30. Prado CMM, Heymsfield SB. Lean Tissue Imaging: A New Era for Nutritional Assessment and Intervention. JPEN J Parenter Enteral Nutr. 2014 Nov;38(8):940–53.
31. Baracos V, Kazemi-Bajestani SMR. Clinical outcomes related to muscle mass in humans with cancer and catabolic illnesses. The International Journal of Biochemistry & Cell Biology. 2013 Oct;45(10):2302–8.
32. Su H, Ruan J, Chen T, Lin E, Shi L. CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis. Cancer Imaging. 2019 Dec;19(1):82.
33. Park HS. Marked Loss of Muscle, Visceral Fat, or Subcutaneous Fat After Gastrectomy Predicts Poor Survival in Advanced Gastric Cancer: Single-Center Study from the CLASSIC Trial. Ann Surg Oncol. 2018 Oct;25(11):3222-3230.
34. Mosk CA, van Vugt JLA, de Jonge H, Witjes CD, Buettner S, Ijzermans JN, van der Laan L. Low skeletal muscle mass as a risk factor for postoperative delirium in elderly patients undergoing colorectal cancer surgery. Clin Interv Aging. 2018 Oct 24;13:2097-2106.
35. Palmela C, Velho S, Agostinho L, Branco F, Santos M, Santos MPC, et al. Body Composition as a Prognostic Factor of Neoadjuvant Chemotherapy Toxicity and Outcome in Patients with Locally Advanced Gastric Cancer. J Gastric Cancer. 2017;17(1):74.
36. Kudou K, Saeki H, Nakashima Y, Edahiro K, Korehisa S, Taniguchi D, Tsutsumi R, Nishimura S, Nakaji Y, Akiyama S, Tajiri H, Nakanishi R, Kurashige J, Sugiyama M, Oki E, Maehara Y. Prognostic Significance of Sarcopenia in Patients with Esophagogastric Junction Cancer or Upper Gastric Cancer. Ann Surg Oncol. 2017 Jul;24(7):1804-1810.
37. Faron A, Sprinkart AM, Kuetting DLR, Feisst A, Isaak A, Endler C, et al. Body composition analysis using CT and MRI: intra- individual intermodal comparison of muscle mass and myosteatosis. Sci Rep. 2020 Dec;10(1):11765.
38. Lee CM, Kang J. Prognostic impact of myosteatosis in patients with colorectal cancer: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2020 Oct;11(5):1270-1282.
39. Srpcic M, Jordan T, Popuri K, Sok M. Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer. Radiol Oncol. 2020 Mar 27;54(2):237-246.
40. Zhuang C-L, Shen X, Huang Y-Y, Zhang F-M, Chen X-Y, Ma L-L, et al. Myosteatosis predicts prognosis after radical gastrectomy for gastric cancer: A propensity score–matched analysis from a large-scale cohort. Surgery. 2019 Sep;166(3):297–304.
41. Zheng, Z.F.; Lu, J.; Zheng, C.H.; Li, P.; Xie, J.W.; Wang, J.B.; Lin, J.X.; Chen, Q.Y.; Lin, M.; Huang, C.M.; et al. A Novel Prognostic Scoring System Based on Preoperative Sarcopenia Predicts the Long-Term Outcome for Patients After R0 Resection for Gastric Cancer: Experiences of a High-Volume Center. Ann. Surg. Oncol. 2017, 24, 1795–1803.
42. Kamarajah SK, Bundred J, Tan BHL. Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis. Gastric Cancer. 2019 Jan;22(1):10–22.
43. Rodrigues V. Is Sarcopenic Obesity an Indicator of Poor Prognosis in Gastric Cancer Surgery? A Cohort Study in a Western Population. J Gastrointest Surg. :16.
44. Takahashi S, Shimizu S, Nagai S, Watanabe H, Nishitani Y, Kurisu Y. Characteristics of sarcopenia after distal gastrectomy in elderly patients. Mogi M, editor. PLoS ONE. 2019 Sep 11;14(9):e0222412.
45. Lee K, Kim KW, Lee J-B, Shin Y, Jang JK, Yook J-H, et al. Impact of remnant stomach volume and anastomosis on nutrition and body composition in gastric cancer patients. Surg Oncol. 2019 Dec;31:75-82.
46. Kugimiya N, Harada E, Oka K, Kawamura D, Suehiro Y, Takemoto Y, et al. Loss of skeletal muscle mass after curative gastrectomy is a poor prognostic factor. Oncol Lett. 2018 Jul;16(1):1341-1347.
47. Park SE, Choi JH, Park JY, Kim BJ, Kim JG, Kim JW, Park JM, Chi KC, Hwang IG. Loss of skeletal muscle mass during palliative chemotherapy is a poor prognostic factor in patients with advanced gastric cancer. Sci Rep. 2020 Oct 19;10(1):17683.
48. Shen Y, Hao Q, Zhou J, Dong B. The impact of frailty and sarcopenia on postoperative outcomes in older patients undergoing gastrectomy surgery: a systematic review and meta-analysis. BMC Geriatr. 2017 Dec;17(1):188.
49. Zanetti M, Gortan Cappellari G, Barazzoni R, Sanson G. The Impact of Protein Supplementation Targeted at Improving Muscle Mass on Strength in Cancer Patients: A Scoping Review. Nutrients. 2020 Jul 16;12(7):2099.
50. Prado CM, Purcell SA, Laviano A. Nutrition interventions to treat low muscle mass in cancer. J Cachexia Sarcopenia Muscle. 2020 Apr;11(2):366–80.
51. Steffl M, Bohannon RW, Sontakova L, Tufano JJ, Shiells K, Holmerova I. Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis. Clin Interv Aging. 2017 May 17;12:835-845.
52. Molenaar CJL, Papen-Botterhuis NE, Herrle F, Slooter GD. Prehabilitation, making patients fit for surgery – a new frontier in perioperative care. Innovative Surgical Sciences. 2019 Dec 18;4(4):132–8.
Published
2022-02-02
How to Cite
FERREIRA, Margarida et al.
SARCOPENIA IN GASTRIC CANCER AND BODY COMPOSITION CHANGES AFTER GASTRECTOMY.
Revista Portuguesa de Cirurgia, [S.l.], n. 51, p. 23-34, feb. 2022.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/883>. Date accessed: 03 oct. 2023.
doi: https://doi.org/10.34635/rpc.883.
Section
Original Papers
