ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Adverse Effects of Low Preoperative Skeletal Muscle Mass
in Patients Undergoing Gastrectomy for Gastric Cancer
Katsunobu Sakurai, MD, PhD, Naoshi Kubo, MD, PhD, Tatsuro Tamura, MD, PhD, Takahiro Toyokawa, MD,
PhD, Ryosuke Amano, MD, PhD, Hiroaki Tanaka, MD, PhD, Kazuya Muguruma, MD, PhD, Masakazu Yashiro,
MD, PhD, Kiyoshi Maeda, MD, PhD, Kosei Hirakawa, MD, PhD, and Masaichi Ohira, MD, PhD
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
Objective. The aim of this study was to determine the
impact of preoperative skeletal muscle mass on short- and
long-term outcomes of patients with gastric cancer (GC)
who undergo gastrectomy.
Methods. A total of 569 patients subjected to gastrectomy
for GC at our institution between January 2007 and
December 2013 were reviewed and skeletal muscle index
(SMI) was measured via cross-sectional, image-based mus-
cle assessment. Computed tomography (CT) and the volume
analyzer SYNAPSE VINCENT were required. Patients were
divided into two groups, with the ﬁrst quartile serving as the
cut-point for both men and women. Clinicopathologic fea-
tures and short- and long-term outcomes were compared.
Results. In multivariate analysis, SMI emerged as an
independent predictor of 5 year overall survival (OS) and
cancer-speciﬁc survival (CSS) in patients with GC. In
subgroup analysis, by stage, patients with stage I disease
and low (vs. high) SMI demonstrated signiﬁcantly worse
5 year OS. The incidence of postoperative complications
did not differ signiﬁcantly by group.
Conclusions. Preoperative SMI, measured in cross-section
using CT, is a useful nutritional determinant that may
predict OS and CSS in patients with GC who undergo
gastrectomy. In our view, nutritional support for sarcopenic
patients with stage I GC, aimed at retaining or adding
skeletal muscle mass, may improve survival. Our analysis
showed no relationship between preoperative SMI and
Some studies have reported that the preoperative nutri-
tional status of cancer patients is associated not only with the
incidence of complication but also with long-term out-
As nutritional parameters, body mass index (BMI)
and serum albumin are well-known and are often used in
practice. BMI is a prevalent, useful marker of nutritional
standing, however the impact of BMI on treatment outcomes
of patients with gastric cancer (GC) is controversial.
Recently, body composition (i.e. skeletal muscle or fat
mass) has become easy to assess, providing greater insight
into nutritional integrity than standard BMI. Therefore,
quantifying skeletal muscle mass has increasingly attracted
attention as a new index of nutritional status.
To quantify skeletal muscle, bioimpedance analysis
(BIA), dual-energy X-ray absorptiometry (DEXA), and
cross-sectional computed tomography (CT) image-based
muscle assessment have been utilized.
CT examination is
regularly conducted in advance of surgery for clinical
staging of GC, therefore assessing skeletal muscle by this
means may be carried out without undue burden on patients.
In recent years, it has become evident that body muscle
mass impacts long-term outcomes in patients with various
types of disorders. For example, in patients slated for living
donor liver transplants, those with low skeletal muscle mass
reportedly fare worse in terms of overall survival (OS) than
those with normal or high skeletal muscle mass.
more, skeletal muscle depletion has been shown to predict
survival of patients with colorectal or respiratory tract can-
however, there is no evidence for such inﬂuence in the
setting of GC. The aim of this study was to clarify the rela-
tionship between preoperative skeletal muscle mass and
Electronic supplementary material The online version of this
article (doi:10.1245/s10434-017-5875-6) contains supplementary
material, which is available to authorized users.
Ó Society of Surgical Oncology 2017
First Received: 29 December 2016;
Published Online: 5 May 2017
K. Sakurai, MD, PhD
Ann Surg Oncol (2017) 24:2712–2719