The TPA score (total psoas muscle area) is the best marker for preoperative measurement of pre-sarcopenia in pancreatic surgery

被引:2
作者
Bougard, M. [1 ]
Barbieux, J. [2 ]
Goulin, J. [1 ]
Parot-Schinkel, E. [3 ]
Vielle, B. [3 ]
Lermite, E. [1 ]
机构
[1] CHU Angers, Digest Surg Dept, F-49933 Angers 9, France
[2] Ctr hospitalier Le Mans, Digest Surg Dept, F-72000 Le Mans, France
[3] CHU Angers, Dept Biostat & Methodol, F-49933 Angers 9, France
关键词
Sarcopenia; Pancreatic surgery; Morbidity; Mortality; TPA score; INTERNATIONAL STUDY-GROUP; SKELETAL-MUSCLE; RESECTION; IMPACT; COMPLICATIONS; FISTULA; ADENOCARCINOMA; DEFINITION; MORTALITY; SURVIVAL;
D O I
10.1016/j.jviscsurg.2022.05.009
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction: Pre-sarcopenia, defined by the loss of muscle mass, is significantly associated with an increased risk of postoperative complications in digestive surgery, particularly pancreatic resection. The five predominant markers of sarcopenia are: psoas muscle area (TPA), intramuscular adipose tissue content (IMAC), Average Hounsfield Unit Calculation (HUAC), Skeletal Muscle Mass Index (MMI), and the ratio between visceral adipose tissue area and muscle surface area (VFA/TAMA). No standard reference marker has been determined. Material and methods: This retrospective cohort included patients who underwent pancreatic resection at the University Hospital of Angers between January 2008 and June 2017. The goal was to determine the marker that was most significantly associated with morbidity and mortality in pancreatic surgery. The secondary objective was to determine the characteristics of pre-sarcopenic patients. Results: The TPA score is the most sensitive marker for identifying patients at highest risk for immediate complications (P = 0.008), proving far more sensitive than MMI (P = 0.02), HUAC (P = 0.34), IMAC (P = 1), or VFA/TAMA (P = 0.42). Postoperative mortality was 3.3% (n = 5), morbidity was 63.8% (n = 97). Pre-sarcopenic patients, as identified by the TPA index had significantly more immediate complications (71.2% versus 49.5%, P = 0.008), in particular, more gastroparesis (P = 0.02) and pancreatic fistula (P = 0.03). Conclusion: In patients requiring pancreatic surgery, the prevalence of pre-sarcopenia is high and seems to be associated with a greater risk of immediate postoperative complications. The TPA score seems to be the most sensitive marker for detecting pre-sarcopenia. Evaluation of TPA preoperatively would make it possible to identify priority patients a priori who might benefit from pre-habilitation programs. (c) 2022 Published by Elsevier Masson SAS.
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页码:4 / 11
页数:8
相关论文
共 26 条
[1]   Imaging of sarcopenia: old evidence and new insights [J].
Albano, Domenico ;
Messina, Carmelo ;
Vitale, Jacopo ;
Sconfienza, Luca Maria .
EUROPEAN RADIOLOGY, 2020, 30 (04) :2199-2208
[2]   Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia [J].
Amini, Neda ;
Spolverato, Gaya ;
Gupta, Rohan ;
Margonis, Georgios A. ;
Kim, Yuhree ;
Wagner, Doris ;
Rezaee, Neda ;
Weiss, Matthew J. ;
Wolfgang, Christopher L. ;
Makary, Martin M. ;
Kamel, Ihab R. ;
Pawlik, Timothy M. .
JOURNAL OF GASTROINTESTINAL SURGERY, 2015, 19 (09) :1593-1602
[3]   Postoperative pancreatic fistula: An international study group (ISGPF) definition [J].
Bassi, C ;
Dervenis, C ;
Butturini, G ;
Fingerhut, A ;
Yeo, C ;
Izbicki, J ;
Neoptolemos, J ;
Sarr, M ;
Traverso, W ;
Buchler, M .
SURGERY, 2005, 138 (01) :8-13
[4]   Preoperative sarcopenia determinants in pancreatic cancer patients [J].
Carrara, Giulia ;
Pecorelli, Nicolo ;
De Cobelli, Francesco ;
Cristel, Giulia ;
Damascelli, Anna ;
Beretta, Luigi ;
Braga, Marco .
CLINICAL NUTRITION, 2017, 36 (06) :1649-1653
[5]   The Clavien-Dindo Classification of Surgical Complications Five-Year Experience [J].
Clavien, Pierre A. ;
Barkun, Jeffrey ;
de Oliveira, Michelle L. ;
Vauthey, Jean Nicolas ;
Dindo, Daniel ;
Schulick, Richard D. ;
de Santibanes, Eduardo ;
Pekolj, Juan ;
Slankamenac, Ksenija ;
Bassi, Claudio ;
Graf, Rolf ;
Vonlanthen, Rene ;
Padbury, Robert ;
Cameron, John L. ;
Makuuchi, Masatoshi .
ANNALS OF SURGERY, 2009, 250 (02) :187-196
[6]   Sarcopenia: revised European consensus on definition and diagnosis [J].
Cruz-Jentoft, Alfonso J. ;
Bahat, Gulistan ;
Bauer, Juergen ;
Boirie, Yves ;
Bruyere, Olivier ;
Cederholm, Tommy ;
Cooper, Cyrus ;
Landi, Francesco ;
Rolland, Yves ;
Sayer, Avan Aihie ;
Schneider, Stephane M. ;
Sieber, Cornel C. ;
Topinkova, Eva ;
Vandewoude, Maurits ;
Visser, Marjolein ;
Zamboni, Mauro .
AGE AND AGEING, 2019, 48 (01) :16-31
[7]   Sarcopenia: European consensus on definition and diagnosis [J].
Cruz-Jentoft, Alfonso J. ;
Baeyens, Jean Pierre ;
Bauer, Juergen M. ;
Boirie, Yves ;
Cederholm, Tommy ;
Landi, Francesco ;
Martin, Finbarr C. ;
Michel, Jean-Pierre ;
Rolland, Yves ;
Schneider, Stephane M. ;
Topinkova, Eva ;
Vandewoude, Maurits ;
Zamboni, Mauro .
AGE AND AGEING, 2010, 39 (04) :412-423
[8]   Sarcopenia and sarcopenic obesity are independent adverse prognostic factors in resectable pancreatic ductal adenocarcinoma [J].
Gruber, Elisabeth S. ;
Jomrich, Gerd ;
Tamandl, Dietmar ;
Gnant, Michael ;
Schindl, Martin ;
Sahora, Klaus .
PLOS ONE, 2019, 14 (05)
[9]   Sarcopenia Is an Independent Predictor of Complications Following Pancreatectomy for Adenocarcinoma [J].
Joglekar, Savita ;
Asghar, Aeen ;
Mott, Sarah L. ;
Johnson, Benjamin E. ;
Button, Anna M. ;
Clark, Eve ;
Mezhir, James J. .
JOURNAL OF SURGICAL ONCOLOGY, 2015, 111 (06) :771-775
[10]   Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications [J].
Jones, K. I. ;
Doleman, B. ;
Scott, S. ;
Lund, J. N. ;
Williams, J. P. .
COLORECTAL DISEASE, 2015, 17 (01) :O20-O26