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Review
. 2023 Mar;105(3):203-211.
doi: 10.1308/rcsann.2021.0290. Epub 2022 Feb 17.

The impact of myosteatosis on outcomes following surgery for gastrointestinal malignancy: a meta-analysis

A MacCormick  1 , A Streeter  2   3 , M Puckett  1 , S Aroori  1
Affiliations
Review

The impact of myosteatosis on outcomes following surgery for gastrointestinal malignancy: a meta-analysis

A MacCormick et al. Ann R Coll Surg Engl. 2023 Mar.

Abstract

Introduction: The aim of this review was to evaluate the impact of preoperative myosteatosis on long-term outcomes following surgery for gastrointestinal malignancy.

Methods: We conducted a systematic search of the electronic information sources, including PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and AMED. Studies were included if they reported the impact of preoperatively defined myosteatosis, or a similar term, on long-term survival outcomes following surgery for gastrointestinal malignancy. A subgroup analysis was performed for those studies reporting outcomes for colorectal cancer patients only.

Findings: Thirty-nine full-text articles were reviewed for inclusion, with 19 being retained after the inclusion criteria were applied. The total number of included patients across all studies was 14,481. Patients with myosteatosis had significantly poorer overall survival, according to univariate (hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.67-1.99) and multivariable (HR 1.66, 95% CI 1.49-1.86) analysis. This was also demonstrated for cancer-specific survival (univariate HR 1.62, 95% CI 1.18-2.22; multivariable HR 1.73, 95% CI 1.48-2.03) and recurrence-free survival (univariate HR 1.28, 95% CI 1.10-1.48; multivariable HR 1.38, 95% CI 1.07-1.77).

Conclusions: This meta-analysis demonstrates that patients with preoperative myosteatosis have poorer long-term survival outcomes following surgery for gastrointestinal malignancy. Therefore, myosteatosis should be used for preoperative optimisation and as a prognostic tool before surgery. More standardised definitions of myosteatosis and further cohort studies of patients with non-colorectal malignancies are required.

Keywords: Malignancy; Meta-analysis; Myosteatosis; Survival.

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Figures

Figure 1
Figure 1
Study flow diagram
Figure 2
Figure 2
Forest plots showing the effect of myosteatosis on (a) overall, (b) cancer-specific and (c) recurrence-free cancer survival for all cancers
Figure 3
Figure 3
Forest plots showing the effect of myosteatosis on (a) overall, (b) cancer-specific and (c) recurrence-free cancer survival in colorectal cancer
See this image and copyright information in PMC

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