title: Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies.
abstract: BACKGROUND
  Preoperative risk assessment in cancer surgery is of importance to improve treatment and outcome. The aim of this study was to assess the impact of CT-assessed sarcopenia on short- and long-term outcomes in patients undergoing surgical resection of gastrointestinal and hepatopancreatobiliary malignancies.
  
  
  METHODS
  A systematic search of Embase, PubMed and Web of Science was performed to identify relevant studies published before 30 September 2014. PRISMA guidelines for systematic reviews were followed. Screening for inclusion, checking the validity of included studies and data extraction were carried out independently by two investigators.
  
  
  RESULTS
  After screening 692 records, 13 observational studies with a total of 2884 patients were included in the analysis. There was wide variation in the reported prevalence of sarcopenia (17.0-79 per cent). Sarcopenia was independently associated with reduced overall survival in seven of ten studies, irrespective of tumour site. Hazard ratios (HRs) of up to 3.19 (hepatic cancer), 1.63 (pancreatic cancer), 1.85 (colorectal cancer) and 2.69 (colorectal liver metastases, CLM) were reported. For oesophageal cancer, the HR was 0.31 for increasing muscle mass. In patients with colorectal cancer and CLM, sarcopenia was independently associated with postoperative mortality (colorectal cancer: odds ratio (OR) 43.3), complications (colorectal cancer: OR 0.96 for increasing muscle mass; CLM: OR 2.22) and severe complications (CLM: OR 3.12).
  
  
  CONCLUSIONS
  Sarcopenia identified before surgery by single-slice CT is associated with impaired overall survival in gastrointestinal and hepatopancreatobiliary malignancies, and increased postoperative morbidity in patients with colorectal cancer with or without hepatic metastases.
authors.affiliation: Department of Surgery, Erasmus MC - University Medical Centre, Wytemaweg 80, 3015 CE Rotterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Levolger
authors.affiliation: Department of Surgery, Erasmus MC - University Medical Centre, Wytemaweg 80, 3015 CE Rotterdam, The Netherlands.
authors.forename: J L A
authors.initials: JL
authors.lastname: van Vugt
authors.affiliation: Department of Surgery, Erasmus MC - University Medical Centre, Wytemaweg 80, 3015 CE Rotterdam, The Netherlands.
authors.forename: R W F
authors.initials: RW
authors.lastname: de Bruin
authors.affiliation: Department of Surgery, Erasmus MC - University Medical Centre, Wytemaweg 80, 3015 CE Rotterdam, The Netherlands.
authors.forename: J N M
authors.initials: JN
authors.lastname: IJzermans
mesh_terms: D001661:Biliary Tract Neoplasms / Q000150:complications / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000601:surgery*; D014943:Global Health; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D009017:Morbidity / Q000639:trends; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D055948:Sarcopenia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D014057:Tomography, X-Ray Computed