TY - JOUR
T1 - Body Composition Is a Predictor for Postoperative Complications After Gastrectomy for Gastric Cancer
T2 - a Prospective Side Study of the LOGICA Trial
AU - Tweed, Thaís T. T.
AU - van der Veen, Arjen
AU - Tummers, Stan
AU - van Dijk, David P. J.
AU - Luyer, Misha D. P.
AU - Ruurda, Jelle P.
AU - van Hillegersberg, Richard
AU - Stoot, Jan H. M. B.
AU - LOGICA Study Group
AU - Tegels, Juul J. W.
AU - Hulsewe, Karel W. E.
AU - Brenkman, Hylke J. F.
AU - Seesing, Maarten F. J.
AU - Nieuwenhuijzen, Grard A. P.
AU - Ponten, Jeroen E. H.
AU - Wijnhoven, Bas P. L.
AU - Lagarde, Sjoerd M.
AU - de Steur, Wobbe O.
AU - Hartgrink, Henk H.
AU - Kouwenhoven, Ewout A.
AU - van Det, Marc J.
AU - Wassenaar, Eelco B.
AU - van der Zaag, Edwin S.
AU - Draaisma, Werner A.
AU - Broeders, Ivo A. M. J.
AU - Gisbertz, Suzanne S.
AU - van Berge Henegouwen, Mark I.
AU - van Laarhoven, Hanneke W. M.
N1 - Funding Information: The authors would like to thank each patient that participated in the LOGICA trial. In addition, the authors would like to thank ZonMW (The Netherlands Organization for Health Research and Development) for the funding of the original LOGICA trial (project number 837002502). Finally, the authors would like to thank everyone who contributed to data collection and local coordination at the 9 participating hospitals of the current study. Publisher Copyright: © 2022, The Author(s).
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Purpose: There is a lack of prospective studies evaluating the effects of body composition on postoperative complications after gastrectomy in a Western population with predominantly advanced gastric cancer. Methods: This is a prospective side study of the LOGICA trial, a multicenter randomized trial on laparoscopic versus open gastrectomy for gastric cancer. Trial patients who received preoperative chemotherapy followed by gastrectomy with an available preoperative restaging abdominal computed tomography (CT) scan were included. The CT scan was used to calculate the mass (M) and radiation attenuation (RA) of skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). These variables were expressed as Z-scores, depicting how many standard deviations each patient’s CT value differs from the sex-specific study sample mean. Primary outcome was the association of each Z-score with the occurrence of a major postoperative complication (Clavien-Dindo grade ≥ 3b). Results: From 2015 to 2018, a total of 112 patients were included. A major postoperative complication occurred in 9 patients (8%). A high SM-M Z-score was associated with a lower risk of major postoperative complications (RR 0.47, 95% CI 0.28–0.78, p = 0.004). Furthermore, high VAT-RA Z-scores and SAT-RA Z-scores were associated with a higher risk of major postoperative complications (RR 2.82, 95% CI 1.52–5.23, p = 0.001 and RR 1.95, 95% CI 1.14–3.34, p = 0.015, respectively). VAT-M, SAT-M, and SM-RA Z-scores showed no significant associations. Conclusion: Preoperative low skeletal muscle mass and high visceral and subcutaneous adipose tissue radiation attenuation (indicating fat depleted of triglycerides) were associated with a higher risk of developing a major postoperative complication in patients treated with preoperative chemotherapy followed by gastrectomy.
AB - Purpose: There is a lack of prospective studies evaluating the effects of body composition on postoperative complications after gastrectomy in a Western population with predominantly advanced gastric cancer. Methods: This is a prospective side study of the LOGICA trial, a multicenter randomized trial on laparoscopic versus open gastrectomy for gastric cancer. Trial patients who received preoperative chemotherapy followed by gastrectomy with an available preoperative restaging abdominal computed tomography (CT) scan were included. The CT scan was used to calculate the mass (M) and radiation attenuation (RA) of skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). These variables were expressed as Z-scores, depicting how many standard deviations each patient’s CT value differs from the sex-specific study sample mean. Primary outcome was the association of each Z-score with the occurrence of a major postoperative complication (Clavien-Dindo grade ≥ 3b). Results: From 2015 to 2018, a total of 112 patients were included. A major postoperative complication occurred in 9 patients (8%). A high SM-M Z-score was associated with a lower risk of major postoperative complications (RR 0.47, 95% CI 0.28–0.78, p = 0.004). Furthermore, high VAT-RA Z-scores and SAT-RA Z-scores were associated with a higher risk of major postoperative complications (RR 2.82, 95% CI 1.52–5.23, p = 0.001 and RR 1.95, 95% CI 1.14–3.34, p = 0.015, respectively). VAT-M, SAT-M, and SM-RA Z-scores showed no significant associations. Conclusion: Preoperative low skeletal muscle mass and high visceral and subcutaneous adipose tissue radiation attenuation (indicating fat depleted of triglycerides) were associated with a higher risk of developing a major postoperative complication in patients treated with preoperative chemotherapy followed by gastrectomy.
KW - Body composition
KW - Chemotherapy
KW - Gastrectomy
KW - Radiation attenuation
KW - Skeletal muscle mass
UR - http://www.scopus.com/inward/record.url?scp=85133853130&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s11605-022-05321-0
DO - https://doi.org/10.1007/s11605-022-05321-0
M3 - Article
C2 - 35488019
SN - 1091-255X
VL - 26
SP - 1373
EP - 1387
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 7
ER -