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Impact of Sarcopenic Obesity on Long-Term Cancer Outcomes and Postoperative Complications After Gastrectomy for Gastric Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The prevalence of sarcopenia in gastric cancer (GC), although varying among the reported studies, is around 60%. In the last few years, it has been recognised that sarcopenia can also occur not only in patients with weight loss and low body weight, but also in patients with normal or increased body mass index. Therefore, the term sarcopenic obesity (SO) is a new definition that further expands the implications of altered body composition. The aim of this study was to assess the impact of SO on the perioperative morbidity and the survival of GC patients undergoing gastrectomy by evaluating body composition on CT images.

Methods

Preoperative CT scans were obtained from all patients with a diagnosis of GC undergoing gastrectomy with curative intent between January 2012 and December 2019. Skeletal muscle mass index (SMMI) and visceral adipose tissue (VAT) cross-sectional area at the level of the transverse processes of the third lumbar vertebra (L3) were measured. Sarcopenia and obesity were defined according to sex-specific cut-off points.

Results

After analysing 190 patients, the prevalence of SO was 21.1% (40 patients) and sarcopenia was 14.7% (28 patients). Multivariate analysis showed that corporal composition was an independent factor of overall survival (p = 0.049). Logistic regression was performed to identify risk factors associated with postoperative complications. SO was identified as a risk factor for serious Clavien-Dindo complications > IIIb/IV [OR 2.82 (1.1–7.1); p = 0.028].

Conclusion

SO was a risk factor for severe postoperative complications as well as worse long-term oncological after a gastrectomy for GC.

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Abbreviations

GC:

Gastric cancer

NACT:

Neoadjuvant chemotherapy

BMI:

Body mass index

CT:

Computed tomography

SO:

Sarcopenic obesity

SMMI:

Skeletal muscle mass index

VAT:

Visceral adipose tissue

SAT:

Subcutaneous adipose tissue

OS:

Overall survival

DFS:

Disease-free survival

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Authors and Affiliations

  1. Division of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Facultad de Medicina, Hospital Universitario Ramón Y Cajal, Universidad de Alcalá, IRYCIS, Ctra. Colmenar Viejo, Km 9.100-28034, Madrid, Spain

    Luz Divina Juez, Pablo Priego, Mariam Bajawi, Marta Cuadrado, Luis A. Blázquez, Silvia Sánchez-Picot, Julio Galindo & José María Fernández-Cebrián

  2. Department of Radiology, Facultad de Medicina, Hospital Universitario Ramón Y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain

    Javier Blázquez

  3. Department of Endocrinology and Nutrition, Facultad de Medicina, Hospital Universitario Ramón Y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain

    Jose I. Botella-Carretero

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  1. Luz Divina Juez
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Correspondence to Pablo Priego.

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Juez, L.D., Priego, P., Bajawi, M. et al. Impact of Sarcopenic Obesity on Long-Term Cancer Outcomes and Postoperative Complications After Gastrectomy for Gastric Cancer. J Gastrointest Surg 27, 35–46 (2023). https://doi.org/10.1007/s11605-022-05492-w

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