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Randomized Controlled Trial
. 2022 Jul;26(7):1373-1387.
doi: 10.1007/s11605-022-05321-0. Epub 2022 Apr 29.

Body Composition Is a Predictor for Postoperative Complications After Gastrectomy for Gastric Cancer: a Prospective Side Study of the LOGICA Trial

Thaís T T Tweed #  1 , Arjen van der Veen #  2 , Stan Tummers  3 , David P J van Dijk  3 , Misha D P Luyer  4 , Jelle P Ruurda  2 , Richard van Hillegersberg  2 , Jan H M B Stoot  3 ; LOGICA study group; Juul J W Tegels, Karel W E Hulsewe, Hylke J F Brenkman, Maarten F J Seesing, Grard A P Nieuwenhuijzen, Jeroen E H Ponten, Bas P L Wijnhoven, Sjoerd M Lagarde, Wobbe O de Steur, Henk H Hartgrink, Ewout A Kouwenhoven, Marc J van Det, Eelco B Wassenaar, Edwin S van der Zaag, Werner A Draaisma, Ivo A M J Broeders, Suzanne S Gisbertz, Mark I van Berge Henegouwen, Hanneke W M van Laarhoven
Affiliations
Randomized Controlled Trial

Body Composition Is a Predictor for Postoperative Complications After Gastrectomy for Gastric Cancer: a Prospective Side Study of the LOGICA Trial

Thaís T T Tweed et al. J Gastrointest Surg. 2022 Jul.

Abstract

Purpose: There is a lack of prospective studies evaluating the effects of body composition on postoperative complications after gastrectomy in a Western population with predominantly advanced gastric cancer.

Methods: This is a prospective side study of the LOGICA trial, a multicenter randomized trial on laparoscopic versus open gastrectomy for gastric cancer. Trial patients who received preoperative chemotherapy followed by gastrectomy with an available preoperative restaging abdominal computed tomography (CT) scan were included. The CT scan was used to calculate the mass (M) and radiation attenuation (RA) of skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). These variables were expressed as Z-scores, depicting how many standard deviations each patient's CT value differs from the sex-specific study sample mean. Primary outcome was the association of each Z-score with the occurrence of a major postoperative complication (Clavien-Dindo grade ≥ 3b).

Results: From 2015 to 2018, a total of 112 patients were included. A major postoperative complication occurred in 9 patients (8%). A high SM-M Z-score was associated with a lower risk of major postoperative complications (RR 0.47, 95% CI 0.28-0.78, p = 0.004). Furthermore, high VAT-RA Z-scores and SAT-RA Z-scores were associated with a higher risk of major postoperative complications (RR 2.82, 95% CI 1.52-5.23, p = 0.001 and RR 1.95, 95% CI 1.14-3.34, p = 0.015, respectively). VAT-M, SAT-M, and SM-RA Z-scores showed no significant associations.

Conclusion: Preoperative low skeletal muscle mass and high visceral and subcutaneous adipose tissue radiation attenuation (indicating fat depleted of triglycerides) were associated with a higher risk of developing a major postoperative complication in patients treated with preoperative chemotherapy followed by gastrectomy.

Keywords: Body composition; Chemotherapy; Gastrectomy; Radiation attenuation; Skeletal muscle mass.

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Conflict of interest statement

All authors and collaborators except the following have no conflict of interest to declare: Misha D. P. Luyer: Consulting or advisory role, Galvani, Medtronic; research funding, Dutch Cancer Foundation; travel, accommodations, expenses, Medtronic. Grard A. P. Nieuwenhuijzen: Consulting or advisory role, Medtronic; research funding, Dutch Cancer Foundation; travel, accommodations, expenses, Medtronic. Jelle P. Ruurda: Consulting or advisory role, Intuitive Surgical. Richard van Hillegersberg: Consulting or advisory role, Intuitive Surgical, Medtronic. Mark I van Berge Henegouwen: Consulting or advisory role, Medtronic; Johnson and Johnson; B. Braun; Alesi Surgical; Mylan; unrestricted grants from Olympus and Stryker. All grants and fees paid to institution.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Histograms showing the timing of the CT scans. *The primary surgery group has one outlier at 160 days. This patient underwent a staging CT scan, followed by an endoscopic submucosal dissection for early stage gastric cancer. Pathological analysis showed dubious radicality and angioinvasion, which prompted extensive cardiac screening of the patient due to comorbidity, followed by distal gastrectomy. This patient did not suffer a severe postoperative complication and was discharged in good clinical condition 10 days after surgery
Fig. 3
Fig. 3
Example CT scans. In the top 2 scans SM, VAT, and SAT are delineated in red, yellow, and blue, respectively. The bottom 2 scans are the same scans without delineations. On the left, a patient is displayed with low Z-scores for VAT-M/SAT-M (low amount of fat) and high Z-scores for VAT-RA/SAT-RA (lighter shade of gray, indicative of low triglyceride concentration) On the right, a patient is displayed with high Z-scores for VAT-M/SAT-M (high amount of fat) and low Z-scores for VAT-RA/SAT-RA (darker shade of gray, indicative of high triglyceride concentration). The body composition of the patient on the left is associated with a higher rate of severe postoperative complications
See this image and copyright information in PMC

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