Impact of sarcopenia on outcomes after pancreatectomy for malignancy. Preliminary results

INTRODUCTION: Sarcopenia, a subclinical loss of skeletal muscle mass, is commonly observed in patients with malignancy. Few studies have examined the association between sarcopenia and out- comes after pancreatic surgery. The aim of this study was to deter- mine the prevalence of sarcopenia among patients who underwent pancreatectomy for cancer and its correlation with morbidity and mortality. METHODS: Skeletal muscle index (SMI) was measured on preop- erative CT imaging in 75 patients undergoing pancreatectomy for cancer between 2010 and 2014. Sarcopenia was defined using pre- viously published sex-adjusted SMI cut-offs. The impact of sarco- penia on morbidity and mortality was assessed relative to other clinico-pathologic factors. RESULTS: Mean age was 66.35 years and 56% were female. Pancreatic adenocarcinoma represented 68% of all cases. Pancrea- ticoduodenectomy was performed in 77.3%. Fifty patients (66.7%) were sarcopenic, 37 (49.4%) were overweight/obese, and 21 (42%) were both (p1⁄4 0.044). Mean SMI among men (46.47 cm2/m2) was greater than among women (36.63 cm2/m2, p1⁄40.001). Univariate analysis found BMI (p1⁄40.001), female sex (p<0.001), and preoperative serum albumin (p1⁄40.004) as predic- tors of sarcopenia. On multivariate analysis, preoperative serum al- bumin was confirmed to be an independent predictor of sarcopenia (p1⁄40.0268). Sarcopenia was associated with a difference, although not significant, in terms of overall morbidity and 90-day mortality (p1⁄40.131 and p1⁄40.735, respectively). CONCLUSIONS: Sarcopenia was present in two-thirds of patients who underwent pancreatectomy for cancer. It is an occult condi- tion in overweight/obese patients, easily identified using CT scans. Preoperative serum albumin is a predictor of sarcopenia. This con- dition is not associated with increased risk of complications or 90- day death.