Characteristics of sarcopenia after distal gastrectomy in elderly patients

Abstract

Presence of preoperative sarcopenia is a risk factor for postoperative complications. However, there are few reports on the presence of sarcopenia and its characteristics following gastrectomy. Sarcopenia is closely related to quality of life in elderly people. To date, the main purpose of follow-up after gastrectomy is surveillance for early detection of recurrence and secondary cancer. However, henceforth, quality of life in elderly gastric cancer patients after gastrectomy must also be evaluated. The present study aimed to investigate sarcopenia during a 1-year postoperative course in elderly gastric cancer patients and examine their characteristics. The subjects were 50 patients aged ≥70 years who underwent laparoscopy-assisted distal gastrectomy for gastric cancer and who experienced no recurrence 1 year postoperatively. Height, weight, serum albumin levels, food intake amount, grip strength, gait speed, visceral fat area, and appendicular skeletal muscle mass index were measured preoperatively and 6 months and 1 year postoperatively. Sarcopenia, obesity, and visceral obesity were diagnosed. Compared with preoperatively, indicators other than height decreased 6 months postoperatively. Compared with 6 months postoperatively, body weight, amount of food intake, and visceral fat area increased by 1 year postoperatively, unlike appendicular skeletal muscle mass index. The frequency of sarcopenia increased 6 months postoperatively compared with preoperatively; this frequency remained almost unchanged 1 year postoperatively compared with 6 months postoperatively. Further, the frequency of visceral obesity increased 1 year postoperatively compared with 6 months postoperatively. Weight increased after > 6 months postoperatively; however, most of the weight increase was in terms of fat and not muscle. We emphasize the importance of considering postoperative sarcopenia and visceral obesity. In particular, sarcopenia and visceral obesity should be carefully monitored after increases in body mass index and food consumption.

Fig 1. Change in SMI preoperatively and 6 months after gastrectomy.

SMI: appendicular skeletal muscle mass index 6.57: SMI cut-off value for diagnosing sarcopenia in men. 4.94: SMI cut-off value for diagnosing sarcopenia in women.

Fig 2. Relationship between gait speed and SMI at 1 year after gastrectomy.

SMI: appendicular skeletal muscle mass index 6.57: SMI cut-off value for diagnosing sarcopenia in men. 4.94: SMI cut-off value for diagnosing sarcopenia in women. 0.8: gait speed cut-off value for diagnosing sarcopenia.

Fig 3. Relationship between the visceral fat area and SMI one year after gastrectomy.

SMI: appendicular skeletal muscle mass index 6.57: SMI cut-off value for diagnosing sarcopenia in men. 4.94: SMI cut-off value for diagnosing sarcopenia in women. There was no correlation between the visceral fat area and SMI at 1 year postoperatively in men (r = 0.048, p = 0.821) and women (r = 0.376, p = 0.150).