Clinical analysis of the effect of sarcopenia on postoperative complications of pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHONG Wan , DONG Shiyang , WANG Han , PAN Chao ,  LIU Zijun

Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P. R. China;

Corresponding author：

LIU Zijun, Email: liuzijundoctor@sina.com

Keywords：

sarcopenia; pancreaticoduodenectomy; pancreatic fistula; pulmonary complication

DOI：

10.7507/1007-9424.202207032

Video：

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Objective To investigate the effect of sarcopenia on postoperative complications in patients undergoing pancreaticoduodenectomy（PD）. Methods The data of 225 patients who underwent pancreaticoduodenectomy in the Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital) from March 2012 to February 2020 were retrospectively analyzed. The total area of the skeletal muscle was measured by CT images at the level of the third lumbar vertebra for the diagnosis of sarcopenia. The patients were divided into sarcopenia group and non-sarcopenia group. The clinical data and surgical complications were compared between the two groups to explore the relationship between sarcopenia and postoperative complications. Results Compared with the non-sarcopenia group, the patients in the sarcopenia group were older and had lower hemoglobin concentration, lower serum albumin concentration, and higher total bilirubin levels (P<0.05). The incidences of clinically relevant pancreatic fistula (grade B and C fistula), pulmonary infection, atelectasis and hypoxemia in the sarcopenia group were significantly higher than those in the non-sarcopenia group (P<0.05). The length of ICU stay and perioperative mortality in the sarcopenia group were significantly higher than those in the non-sarcopenia group (P<0.05). Multivariate analysis showed that sarcopenia, preoperative total bilirubin level, pancreatic duct diameter and pancreatic texture were independent risk factors for clinically relevant pancreatic fistula (P<0.05). Sarcopenia, intraoperative blood loss and postoperative abdominal infection were independent risk factors for pulmonary complications after PD (P<0.05). Conclusions Sarcopenia is an independent risk factor for increased incidence of clinically relevant pancreatic fistula and pulmonary complications after PD. Strengthening perioperative nutritional therapy and rehabilitation exercise in patients with sarcopenia is of great significance to reduce postoperative complications of PD.

Citation： ZHONG Wan, DONG Shiyang, WANG Han, PAN Chao, LIU Zijun. Clinical analysis of the effect of sarcopenia on postoperative complications of pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(12): 1611-1617. doi: 10.7507/1007-9424.202207032 Copy

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2.	Zhang W, Huang Z, Zhang J, et al. Safety and effectiveness of open pancreaticoduodenectomy in adults aged 70 or older: A meta-analysis. J Geriatr Oncol, 2021, 12(7): 1136-1145.
3.	Shen Z, Zhang J, Zhao S, et al. Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: A retrospective and propensity score-matched analysis. Pancreatology, 2020, 20(3): 529-536.
4.	Jin J, Xiong G, Wang X, et al. The Impact of Preoperative and Postoperative Malnutrition on Outcomes for Ampullary Carcinoma After Pancreaticoduodenectomy. Front Oncol, 2021, 11: 748341. doi: 10.3389/ fonc. 2021.748341.
5.	Lee B, Han HS, Yoon YS, et al. Impact of preoperative malnutrition, based on albumin level and body mass index, on operative outcomes in patients with pancreatic head cancer. J Hepatobiliary Pancreat Sci, 2021, 28(12): 1069-1075.
6.	Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307.
7.	Gianotti L, Sandini M. The 2019 ESPEN Arvid Wretlind lecture perioperative nutritional and metabolic care: Patient-tailored or organ-specific approach? Clin Nutr, 2020, 39(8): 2347-2357.
8.	Jones K, Gordon-Weeks A, Coleman C, et al. Radiologically determined sarcopenia predicts morbidity and mortality following abdominal surgery: A systematic review and meta-analysis. World J Surg, 2017, 41(9): 2266-2279.
9.	Su H, Ruan J, Chen T, et al. 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, 19(1): 82. doi: 10.1186/s40644-019-0270-0.
10.	Duan K, Gao X, Wei L, et al. Skeletal muscle depletion and nutrition support affected postoperative complications in patients who underwent pancreatoduodenectomy. Eur J Clin Nutr, 2021, 75(8): 1218-1226.
11.	Nauheim DO, Hackbart H, Papai E, et al. Preoperative sarcopenia is a negative predictor for enhanced postoperative recovery after pancreaticoduodenectomy. Langenbecks Arch Surg, 2022, 407(6): 2355-2362.
12.	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
13.	Wu CH, Chang MC, Lyadov VK, et al. Comparing Western and Eastern criteria for sarcopenia and their association with survival in patients with pancreatic cancer. Clin Nutr, 2019, 38(2): 862-869.
14.	中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会, 中华外科杂志编辑部. 胰腺术后外科常见并发症诊治及预防的专家共识(2017). 中华外科杂志, 2017, 55(5): 328-334.
15.	中华预防医学会医院感染控制分会第四届委员会重点部位感染防控学组. 术后肺炎预防和控制专家共识. 中华临床感染病杂志, 2018, 11(1): 11-19.
16.	Peng P, Hyder O, Firoozmand A, et al. Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg, 2012, 16(8): 1478-1486.
17.	Cannataro R, Carbone L, Petro JL, et al. Sarcopenia: etiology, nutritional approaches, and miRNAs. Int J Mol Sci, 2021, 22(18): 9724. doi: 10.3390/ijms22189724.
18.	Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing, 2010, 39(4): 412-423.
19.	Bihari S, Bannard-Smith J, Bellomo R. Albumin as a drug: its biological effects beyond volume expansion. Crit Care Resusc, 2020, 22(3): 257-265.
20.	Kawaida H, Kono H, Hosomura N, et al. Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery. World J Gastroenterol, 2019, 25(28): 3722-3737.
21.	Liang H, Wu JG, Wang F, et al. Choice of operative method for pancreaticojejunostomy and a multivariable study of pancreatic leakage in pancreaticoduodenectomy. World J Gastrointest Surg, 2021, 13(11): 1405-1413.
22.	Sert OZ, Berkesoglu M, Canbaz H, et al. The factors of pancreatic fistula development in patients who underwent classical pancreaticoduodenectomy. Ann Ital Chir, 2021, 92: 35-40.
23.	Nishida Y, Kato Y, Kudo M, et al. Preoperative sarcopenia strongly influences the risk of postoperative pancreatic fistula formation after pancreaticoduodenectomy. J Gastrointest Surg, 2016, 20(9): 1586-1594.
24.	Kirihara Y, Takahashi N, Hashimoto Y, et al. Prediction of pancreatic anastomotic failure after pancreatoduodenectomy: the use of preoperative, quantitative computed tomography to measure remnant pancreatic volume and body composition. Ann Surg, 2013, 257(3): 512-519.
25.	Makiura D, Ono R, Inoue J, et al. Preoperative sarcopenia is a predictor of postoperative pulmonary complications in esophageal cancer following esophagectomy: A retrospective cohort study. J Geriatr Oncol, 2016, 7(6): 430-436.
26.	Altuna-Venegas S, Aliaga-Vega R, Maguiña JL, et al. Risk of community-acquired pneumonia in older adults with sarcopenia of a hospital from Callao, Peru 2010-2015. Arch Gerontol Geriatr, 2019, 82: 100-105.
27.	Nagle RT, Leiby BE, Lavu H, et al. Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy. Surgery, 2017, 161(4): 959-967.
28.	Bauer JM, Verlaan S, Bautmans I, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc, 2015, 16(9): 740-747.
29.	Vikberg S, Sörlén N, Brandén L, et al. Effects of resistance training on functional strength and muscle mass in 70-year-old individuals with pre-sarcopenia: A randomized controlled trial. J Am Med Dir Assoc, 2019, 20(1): 28-34.
30.	Martínez-Arnau FM, Fonfría-Vivas R, Buigues C, et al. Effects of leucine administration in sarcopenia: A randomized and placebo-controlled clinical trial. Nutrients, 2020, 12(4): 932. doi: 10.3390/nu12040932.
31.	Tumas J, Tumiene B, Jurkeviciene J, et al. Nutritional and immune impairments and their effects on outcomes in early pancreatic cancer patients undergoing pancreatoduodenectomy. Clin Nutr, 2020, 39(11): 3385-3394.

1. Simon R. Complications after pancreaticoduodenectomy. Surg Clin North Am, 2021, 101(5): 865-874.
2. Zhang W, Huang Z, Zhang J, et al. Safety and effectiveness of open pancreaticoduodenectomy in adults aged 70 or older: A meta-analysis. J Geriatr Oncol, 2021, 12(7): 1136-1145.
3. Shen Z, Zhang J, Zhao S, et al. Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: A retrospective and propensity score-matched analysis. Pancreatology, 2020, 20(3): 529-536.
4. Jin J, Xiong G, Wang X, et al. The Impact of Preoperative and Postoperative Malnutrition on Outcomes for Ampullary Carcinoma After Pancreaticoduodenectomy. Front Oncol, 2021, 11: 748341. doi: 10.3389/ fonc. 2021.748341.
5. Lee B, Han HS, Yoon YS, et al. Impact of preoperative malnutrition, based on albumin level and body mass index, on operative outcomes in patients with pancreatic head cancer. J Hepatobiliary Pancreat Sci, 2021, 28(12): 1069-1075.
6. Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307.
7. Gianotti L, Sandini M. The 2019 ESPEN Arvid Wretlind lecture perioperative nutritional and metabolic care: Patient-tailored or organ-specific approach? Clin Nutr, 2020, 39(8): 2347-2357.
8. Jones K, Gordon-Weeks A, Coleman C, et al. Radiologically determined sarcopenia predicts morbidity and mortality following abdominal surgery: A systematic review and meta-analysis. World J Surg, 2017, 41(9): 2266-2279.
9. Su H, Ruan J, Chen T, et al. 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, 19(1): 82. doi: 10.1186/s40644-019-0270-0.
10. Duan K, Gao X, Wei L, et al. Skeletal muscle depletion and nutrition support affected postoperative complications in patients who underwent pancreatoduodenectomy. Eur J Clin Nutr, 2021, 75(8): 1218-1226.
11. Nauheim DO, Hackbart H, Papai E, et al. Preoperative sarcopenia is a negative predictor for enhanced postoperative recovery after pancreaticoduodenectomy. Langenbecks Arch Surg, 2022, 407(6): 2355-2362.
12. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
13. Wu CH, Chang MC, Lyadov VK, et al. Comparing Western and Eastern criteria for sarcopenia and their association with survival in patients with pancreatic cancer. Clin Nutr, 2019, 38(2): 862-869.
14. 中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会, 中华外科杂志编辑部. 胰腺术后外科常见并发症诊治及预防的专家共识(2017). 中华外科杂志, 2017, 55(5): 328-334.
15. 中华预防医学会医院感染控制分会第四届委员会重点部位感染防控学组. 术后肺炎预防和控制专家共识. 中华临床感染病杂志, 2018, 11(1): 11-19.
16. Peng P, Hyder O, Firoozmand A, et al. Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg, 2012, 16(8): 1478-1486.
17. Cannataro R, Carbone L, Petro JL, et al. Sarcopenia: etiology, nutritional approaches, and miRNAs. Int J Mol Sci, 2021, 22(18): 9724. doi: 10.3390/ijms22189724.
18. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing, 2010, 39(4): 412-423.
19. Bihari S, Bannard-Smith J, Bellomo R. Albumin as a drug: its biological effects beyond volume expansion. Crit Care Resusc, 2020, 22(3): 257-265.
20. Kawaida H, Kono H, Hosomura N, et al. Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery. World J Gastroenterol, 2019, 25(28): 3722-3737.
21. Liang H, Wu JG, Wang F, et al. Choice of operative method for pancreaticojejunostomy and a multivariable study of pancreatic leakage in pancreaticoduodenectomy. World J Gastrointest Surg, 2021, 13(11): 1405-1413.
22. Sert OZ, Berkesoglu M, Canbaz H, et al. The factors of pancreatic fistula development in patients who underwent classical pancreaticoduodenectomy. Ann Ital Chir, 2021, 92: 35-40.
23. Nishida Y, Kato Y, Kudo M, et al. Preoperative sarcopenia strongly influences the risk of postoperative pancreatic fistula formation after pancreaticoduodenectomy. J Gastrointest Surg, 2016, 20(9): 1586-1594.
24. Kirihara Y, Takahashi N, Hashimoto Y, et al. Prediction of pancreatic anastomotic failure after pancreatoduodenectomy: the use of preoperative, quantitative computed tomography to measure remnant pancreatic volume and body composition. Ann Surg, 2013, 257(3): 512-519.
25. Makiura D, Ono R, Inoue J, et al. Preoperative sarcopenia is a predictor of postoperative pulmonary complications in esophageal cancer following esophagectomy: A retrospective cohort study. J Geriatr Oncol, 2016, 7(6): 430-436.
26. Altuna-Venegas S, Aliaga-Vega R, Maguiña JL, et al. Risk of community-acquired pneumonia in older adults with sarcopenia of a hospital from Callao, Peru 2010-2015. Arch Gerontol Geriatr, 2019, 82: 100-105.
27. Nagle RT, Leiby BE, Lavu H, et al. Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy. Surgery, 2017, 161(4): 959-967.
28. Bauer JM, Verlaan S, Bautmans I, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc, 2015, 16(9): 740-747.
29. Vikberg S, Sörlén N, Brandén L, et al. Effects of resistance training on functional strength and muscle mass in 70-year-old individuals with pre-sarcopenia: A randomized controlled trial. J Am Med Dir Assoc, 2019, 20(1): 28-34.
30. Martínez-Arnau FM, Fonfría-Vivas R, Buigues C, et al. Effects of leucine administration in sarcopenia: A randomized and placebo-controlled clinical trial. Nutrients, 2020, 12(4): 932. doi: 10.3390/nu12040932.
31. Tumas J, Tumiene B, Jurkeviciene J, et al. Nutritional and immune impairments and their effects on outcomes in early pancreatic cancer patients undergoing pancreatoduodenectomy. Clin Nutr, 2020, 39(11): 3385-3394.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical analysis of the effect of sarcopenia on postoperative complications of pancreaticoduodenectomy

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