title: Impact of preoperative hand grip strength on morbidity following gastric cancer surgery.
abstract: BACKGROUND
  Sarcopenia is a decrease in both muscle mass and strength. It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery. This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery.
  
  
  METHODS
  A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined. Patients with performance status 3 or 4 were excluded. Preoperative lean body mass (LBM) was evaluated by bioelectrical impedance analysis and expressed as LBM index. Preoperative muscle function was measured by hand grip strength (HGS). The cutoff values were the gender-specific lowest 20 %. Grade 2 or higher morbidities, as retrospectively evaluated by the Clavien-Dindo classification, were obtained from the patient record. The risk factors for morbidity were examined by univariate and multivariate analyses.
  
  
  RESULTS
  Morbidity was observed in 39 patients (13.3 %), including 7 with pancreatic leakage, 12 with anastomotic leakage, and 4 with intraabdominal abscesses, but no mortality was observed. The univariate analysis showed that male gender, total gastrectomy, splenectomy, and a low HGS were significant risk factors for morbidity. A low LBM was not a significant risk factor. A low HGS, male gender, and total gastrectomy remained significant in the multivariate analysis.
  
  
  CONCLUSIONS
  A low hand grip strength was a significant risk factor for morbidity after gastric cancer surgery. The importance of the hand grip strength as a risk factor should be examined in future prospective studies.
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.|Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.|Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.affiliation: Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.|Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Kenki
authors.initials: K
authors.lastname: Segami
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.|Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Taiichi
authors.initials: T
authors.lastname: Kawabe
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.|Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Fujikawa
authors.affiliation: Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshima
authors.affiliation: Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.affiliation: Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogata
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Cho
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-Shi, Kanagawa-ken, 241-8515, Japan. yoshikawat@kcch.jp.|Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-Shi, Kanagawa-ken, 236-0004, Japan. yoshikawat@kcch.jp.
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000209:etiology*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Clavien–Dindo classification; Gastric cancer; Hand grip strength; Morbidity (3–5); Sarcopenia