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Sarcopenia assessed with DXA and CT increases the risk of perioperative complications in patients with gastrectomy

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We investigated sarcopenia prevalence using various diagnostic criteria based on dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) in gastric cancer patients who underwent gastrectomy, and evaluated the association between sarcopenia and perioperative complications.

Methods

This retrospective study included consecutive patients with gastric cancer who underwent gastrectomy, and preoperative DXA and CT from January 2013 to November 2020. Body composition was measured using DXA and CT. Height-adjusted DXA-based Appendicular Skeletal Muscle Mass Index (ASMI) and CT-based skeletal muscle cross-sectional area at the L3 level (SMI) were measured. Sarcopenia and sarcopenic obesity were defined using reported cutoff values. The chi-square test and univariate analysis were performed to determine risk factors for significant and severe perioperative complications (Clavien–Dindo Grades ≥ 2 and ≥ 3, respectively).

Results

In total, 77 males and 43 females aged 61.4 ± 11.0 years were included. ASMI and SMI were correlated (r = 0.819), but sarcopenia prevalence varied (20.0–63.3%), depending on the criteria applied. Univariate analysis revealed sarcopenia defined using the Asian Working Group on Sarcopenia (AWGS) criteria and sarcopenic obesity as risk factors for significant (odds ratio [OR] 2.76, p = 0.030 vs. OR 4.31, p = 0.002) and severe perioperative complications (OR 3.77, p = 0.036 vs. OR 4.78, p = 0.010). In subgroup analyses, sarcopenia and sarcopenic obesity were significantly associated with perioperative complications only in males.

Conclusion

Perioperative complication risk can be predicted from sarcopenia defined using the AWGS criteria and sarcopenic obesity measured using DXA and CT, particularly in males.

Key points

• The prevalence of sarcopenia varies due to definition differences.

• Sarcopenia and sarcopenic obesity are risk factors for significant and severe perioperative complications, particularly in males.

• Our results suggest that physicians need to pay attention to perioperative complications after surgical treatment of male patients with sarcopenia and sarcopenic obesity.

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Data availability

The datasets generated during the current study are not publicly available due to but are available from the corresponding author on reasonable request.

Abbreviations

ASMI:

Appendicular Skeletal Muscle Mass Index

AWGS:

Asian Working Group on Sarcopenia

BMI:

Body mass index

CD:

Clavien–Dindo classification

CI:

Confidential interval

CT:

Computed tomography

DM:

Diabetes mellitus

DXA:

Dual-energy X-ray absorptiometry

EWGSOP:

European Working Group on Sarcopenia in Older People

HTN:

Hypertension

HU:

Hounsfield unit

IWGS:

International Working Group on Sarcopenia

KNHANES:

Korean National Health and Nutrition Examination Survey

OR:

Odds ratio

SD:

Standard deviation

SMI:

Skeletal muscle index

TAM:

Total abdominal muscle area

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Acknowledgements

This work was supported by a grant from Hanyang University.

Funding

This work has received research funding by Hanyang University (HY-202200000001247).

Author information

Authors and Affiliations

  1. Department of Radiology, Hanyang University Medical Center, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea

    Mimi Kim, Chul-min Lee & Bo Kyeong Kang

  2. Department of Surgery, Hanyang University Medical Center, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea

    Tae Kyung Ha

  3. Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea

    Yun Young Choi & Soo Jin Lee

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Correspondence to Soo Jin Lee.

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Guarantor

Dr. Soo Jin Lee takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

The medial ethics review boards of the Hanyang University Medical Center (IRB No. 2022–06-038).

Methodology

• Retrospective

• Observational

• Performed at one institution

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Kim, M., Lee, Cm., Kang, B.K. et al. Sarcopenia assessed with DXA and CT increases the risk of perioperative complications in patients with gastrectomy. Eur Radiol 33, 5150–5158 (2023). https://doi.org/10.1007/s00330-023-09401-w

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