Myosteatosis predicts postoperative complications and long-term survival in robotic gastrectomy for gastric cancer: A propensity score analysis

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL European Journal of Clinical Investigation Pub Date : 2024-03-27 DOI:10.1111/eci.14201

Pingan Ding, Jiaxiang Wu, Haotian Wu, Tongkun Li, Jiaxuan Yang, Li Yang, Honghai Guo, Yuan Tian, Peigang Yang, Lingjiao Meng, Qun Zhao

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Abstract

Background

Robotic gastrectomy is increasingly utilized for gastric cancer, but high morbidity remains a concern. Myosteatosis or low skeletal muscle density reflecting fatty infiltration, associates with complications after other cancer surgeries but has not been evaluated for robotic gastrectomy.

Methods

This retrospective study analysed 381 patients undergoing robotic gastrectomy for gastric cancer from September 2019 to October 2022. Myosteatosis was quantified on preoperative computed tomography (CT) images at lumbar 3 (L3). Propensity score matching addressed potential confounding between myosteatosis and non-myosteatosis groups. Outcomes were postoperative complications, 30 days mortality, 30 days readmissions and survival.

Results

Myosteatosis was present in 33.6% of patients. Myosteatosis associated with increased overall (47.7% vs. 26.5%, p < 0.001) and severe complications (12.4% vs. 4.9%, p < 0.001). After matching, myosteatosis remained associated with increased overall complications, major complications, intensive care unit (ICU) transfer and readmission (all p < 0.05). Myosteatosis independently predicted overall [odds ratio (OR) = 2.86, 95% confidence interval (CI): 1.57–5.20, p = 0.001] and severe complications (OR = 4.81, 95% CI: 1.51–15.27, p = 0.008). Myosteatosis also associated with reduced overall (85.0% vs. 93.2%, p = 0.015) and disease-free survival (80.3% vs. 88.4%, p=0.029). On multivariate analysis, myosteatosis independently predicted poorer survival [hazard ratio (HR) = 2.83, 95% CI: 1.32–6.08, p=0.012] and disease-free survival (HR = 1.83, 95% CI: 1.01–3.30, p=0.032).

Conclusion

Preoperative CT-defined myosteatosis independently predicts increased postoperative complications and reduced long-term survival after robotic gastrectomy for gastric cancer. Assessing myosteatosis on staging CT could optimize preoperative risk stratification.

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肌营养不良可预测胃癌机器人胃切除术的术后并发症和长期生存率：倾向评分分析

背景：越来越多的胃癌患者采用机器人胃切除术，但高发病率仍是一个令人担忧的问题。肌营养不良或骨骼肌密度低反映了脂肪浸润，与其他癌症手术后的并发症有关，但尚未对机器人胃切除术进行评估：这项回顾性研究分析了2019年9月至2022年10月期间接受机器人胃切除术的381名胃癌患者。术前对腰椎3（L3）处的计算机断层扫描（CT）图像进行了肌骨质疏松症量化。倾向评分匹配解决了肌骨异常组和非肌骨异常组之间潜在的混杂问题。结果包括术后并发症、30天死亡率、30天再住院率和存活率：结果：33.6%的患者患有肌骨病。结果：33.6%的患者存在肌骨质疏松症，肌骨质疏松症与总体死亡率增加有关（47.7% vs. 26.5%，P 结论：肌骨质疏松症与总体死亡率增加有关：术前 CT 定义的骨质疏松可独立预测胃癌机器人胃切除术后并发症的增加和长期生存率的降低。在分期 CT 上评估肌骨肥大可优化术前风险分层。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.