Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy.
BACKGROUND
Skeletal muscle loss is associated with physical disability, nosocomial infections, postoperative complications, and decreased survival. Preventing the loss of skeletal muscle mass after gastrectomy may lead to improved outcomes. The aims of this study were to assess changes in skeletal muscle mass after total gastrectomy (TG) and to clarify the clinical factors affecting significant loss of skeletal muscle after TG.


METHODS
One hundred and two patients undergoing TG for primary gastric cancer underwent abdominal computed tomography before and 1 year after TG to precisely quantify postoperative changes in skeletal muscle and adipose tissue. Univariate and multivariate logistic regression analyses identified clinical factors contributing to significant loss of skeletal muscle after TG.


RESULTS
At 1 year after TG, the mass of both skeletal muscle and adipose tissue was reduced by 6.20 ± 6.80 and 65.8 ± 36.1% of the preoperative values, respectively, and 26 patients (25.5%) showed a significant loss of skeletal muscle of more than 10%. Adjuvant chemotherapy with S-1 for ≥6 months (hazard ratio 26.61, 95% confidence interval, 3.487-203.1) was identified as the single independent risk factor for a significant loss of skeletal muscle.


CONCLUSIONS
Skeletal muscle loss was exacerbated by extended adjuvant chemotherapy after TG. Further research should identify appropriate nutritional interventions for maintaining skeletal muscle mass and leading to improved outcomes.
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan, yamaoka.yusuke@gmail.com.
Yusuke
Y
Yamaoka
Kazumasa
K
Fujitani
Toshimasa
T
Tsujinaka
Kazuyoshi
K
Yamamoto
Motohiro
M
Hirao
Mitsugu
M
Sekimoto
D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000175:diagnosis / Q000209:etiology*; D013274:Stomach Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery