Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer Sarcopenia in overweight and obese patients is a predictive factor for postoperative complication in gastric cancer: A prospective study. Sarcopenia Adversely Impacts Postoperative Clinical Outcomes Following Gastrectomy in Patients with Gastric Cancer: A Prospective Study Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Sarcopenic Obesity Is Associated with Severe Postoperative Complications in Gastric Cancer Patients Undergoing Gastrectomy: a Prospective Study Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy. The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) randomized controlled trial: design and methods Prognostic Significance of Sarcopenia in Patients with Esophagogastric Junction Cancer or Upper Gastric Cancer Computed tomography-derived skeletal muscle index: A novel predictor of frailty and hospital length of stay after transcatheter aortic valve replacement. A Novel Nomogram for Predicting Postsurgical Intra-abdominal Infection in Gastric Cancer Patients: a Prospective Study Sarcopenia is associated with the neutrophil/lymphocyte and platelet/lymphocyte ratios in operable gastric cancer patients: a prospective study Impact of preoperative hand grip strength on morbidity following gastric cancer surgery Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Cumulative deficit model of geriatric assessment to predict the postoperative outcomes of older patients with solid abdominal cancer. Frailty Intervention Trial (FIT) Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Sarcopenia in ovarian cancer patients, oncologic outcomes revealing the importance of clinical nutrition: review of literature. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer Body Mass Index Does Not Affect Systematic D2 Lymph Node Dissection and Postoperative Morbidity in Gastric Cancer Patients Effect of immunotherapy and spleen preservation on immunological function in patients with gastric cancer. Value of sarcopenia assessed by computed tomography for the prediction of postoperative morbidity following oncological colorectal resection: A comparison with the malnutrition screening tool.
Background . The association between sarcopenia and postoperative outcomes has been well reported . However , the impact of different sarcopenia stages on postoperative outcomes has never been investigated . Methods . We conducted a large , prospect i ve study of patients who underwent radical gastrectomy for gastric cancer from August 2014 to December 2015 .  Sarcopenia was staged as “ presarcopenia , ” “ sarcopenia , ” and “ severe sarcopenia ” according to the definition of the European Working Group on Sarcopenia in Older People . Univariate and multivariate analyses evaluating the risk factors for total , surgical , and medical complications were performed . Results . A total of 470 patients were included , in which 20.6 % , 10 % , and 6.8 % of the patients were identified as having “ presarcopenia , ” “ sarcopenia , ” and “ severe sarcopenia  , ” respectively . Postoperative complications , duration of hospital stays , and costs increased with advancing sarcopenia stages . Severe sarcopenia , visceral fat area to total abdominal muscle area ratio , American Society of Anesthesiologists grade III , and tumor located at the cardia were independent risk factors for total complications . Visceral fat area to total abdominal muscle area ratio and tumor located at the cardia were independent risk factors for operative complications . Presarcopenia , sarcopenia , and severe sarcopenia were all identified as independent risk factors for medical complications , as well as age ≥75 years and Charlson Comorbidity Index . Conclusion . Patients had worse  postoperative outcomes after gastric cancer operation with advancing sarcopenia stages . Severe sarcopenia , but not presarcopenia or sarcopenia , was an independent risk factor for total postoperative complications . The 3 sarcopenia stages independently influence medical but not surgical complications . Recognizing sarcopenia stages is important for preoperative risk stratification Abstract Currently , the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated . Moreover , the association between sarcopenia and postoperative complications remains controversial . This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer . From December 2008 to April 2013 , the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospect ively . Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis . Skeletal muscle mass was determined by abdominal ( computed tomography ) CT scan , and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification . Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed . A total of 937 patients were included in this study , and 389 ( 41.5 % ) patients were sarcopenic based on the diagnostic cut-off values ( 34.9 cm2/m2 for women and 40.8 cm2/m2 for men ) . Sarcopenia was an independent risk factor for severe postoperative complications ( OR = 3.010 , P < 0.001 ) , but not for total complications . However , sarcopenia did not show significant association with operative mortality . Moreover , sarcopenia was an independent predictor for poorer overall survival ( HR = 1.653 , P < 0.001 ) and disease-free survival ( HR = 1.620 , P < 0.001 ) . Under the adjusted tumor-node-metastasis ( TNM ) stage , sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III , but not in patients with TNM stage I.Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer . Moreover , sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III , but not in patients with TNM stage BACKGROUND Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength . This study aims to explore the prevalence of sarcopenia in overweight and obese gastric cancer ( GC ) patients and figured out the impacts of sarcopenia on the postoperative complication of overweight and obese GC patients . METHODS According to the recommended body-mass index ( BMI ) for Asian population s by WHO , we conducted a prospect i ve study of overweight and obese gastric cancer patients ( BMI ≥ 23 kg/m2 ) under curative gastrectomy from August 2014 to December 2015 . Including  lumbar skeletal muscle index , h and grip strength and gait speed as the sarcopenic components were measured before surgery . Patients were followed up after gastrectomy to gain the actual clinical outcomes . Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis . RESULTS Total of 206 overweight or obese patients were enrolled in this study , 14 patients were diagnosed sarcopenia and were demonstrated having significantly association with higher risk of postoperative complications , higher hospital costs , and higher rate of 30-days readmission compared with the non-sarcopenic ones . On the basis of univariate and multivariate analysis , sarcopenia was an independent risk factor for postoperative complication of overweight and obese patients with gastric cancer ( P = 0.002 ) . CONCLUSION Sarcopenia is an independent predictor of postoperative complications in overweight or obese patients with gastric cancer after radical gastrectomy Background Sarcopenia is characterized by decreased skeletal muscle plus low muscle strength and /or physical performance . This study was performed to determine the association of sarcopenia with short-term postoperative outcomes after gastrectomy for gastric cancer . Methods We conducted a prospect i ve study of 255 consecutive patients with gastric cancer who underwent curative gastrectomy .  The sarcopenia elements , including lumbar skeletal muscle index , h and grip strength , and gait speed , were measured before surgery . Patients were followed up after gastrectomy to gain the actual clinical outcomes . Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis . Results Sarcopenia was present in 32 of 255 patients ( 12.5 % ) , and was significantly correlated with advance age , lower body mass index , higher nutritional risk screening ( NRS ) 2002 score , and lower preoperative serum albumin and hemoglobin . Compared with non-sarcopenic patients , sarcopenic patients had a higher risk of postoperative complications , longer postoperative hospital stay , and more hospital costs . In univariate analysis , sarcopenia ( p < 0.001 ) , nutritional risk ( NRS 2002 score ≥3 ; p = 0.003 ) , advanced age ( ≥75 years ; p = 0.014 ) , anemia ( p = 0.012 ) , hypoalbuminemia ( p = 0.029 ) , and diabetes ( p = 0.014 ) were associated with postoperative complications . Multivariable analysis revealed that sarcopenia ( p < 0.001 ) and diabetes ( p = 0.006 ) were independent predictors of postoperative complications . Conclusions Sarcopenia is an independent predictor of postoperative complications in patients with gastric cancer after gastrectomy Purpose One-year mortality is vital for elderly oncologic patients undergoing surgery . Recent studies have demonstrated that sarcopenia can predict outcomes after major abdominal surgeries , but the association of sarcopenia and 1-year mortality has never been investigated in a prospect i ve study . Methods We conducted a prospect i ve study of elderly patients ( ≥65 years ) who underwent curative gastrectomy for gastric cancer from July 2014 to July 2015 . Sarcopenia was determined by the measurements of muscle mass , h and grip strength , and gait speed . Univariate and multivariate analyses were used to identify the risk factors associated with 1-year mortality . Results A total of 173 patients were included , in which 52 ( 30.1 % ) patients were identified as having sarcopenia . Twenty-four ( 13.9 % ) patients died within 1 year of surgery . Multivariate analysis showed that sarcopenia was an independent risk factor for 1-year mortality . Area under the receiver operating characteristic curve demonstrated an increased predictive power for 1-year mortality with the inclusion of sarcopenia , from 0.835 to 0.868 . Solely low muscle mass was not predictive of 1-year mortality in the multivariate analysis . Conclusions Sarcopenia is predictive of 1-year mortality in elderly patients undergoing gastric cancer surgery . The measurement of muscle function is important for sarcopenia as a preoperative assessment tool OBJECTIVE To determine the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery . BACKGROUND Functional compromise in elderly colorectal surgical patients is considered as a significant factor of impaired postoperative recovery . Therefore , the predictive value of preoperative functional compromise assessment was investigated . Sarcopenia is a hallmark of functional compromise . METHODS A total of 310 consecutive patients who underwent oncologic colorectal surgery  were included in a prospect i ve digital data base . Sarcopenia was assessed using the L3 muscle index utilizing Osirix on preoperative computed tomography . Groningen Frailty Indicator and Short Nutritional Assessment Question naire scores were used to assess frailty and nutritional compromise . Predictors for anastomotic leakage , sepsis , and mortality were analyzed by logistic regression analysis . RESULTS Age was an independent predictor of mortality [ P = 0.04 ; odds ratio , 1.17 ; 95 % confidence interval ( CI ) , 1.01 - 1.37 ] . Thirty-day/in-hospital mortality rate in sarcopenic patients was 8.8 % versus 0.7 % in nonsarcopenic patients ( P = 0.001 ; odds ratio , 15.5 ; 95 % CI , 2.00 - 120 ) . Sarcopenia was not predictive for anastomotic leakage or sepsis . Combination of high  Short Nutritional Assessment Question naire score , high Groningen Frailty Indicator score , and sarcopenia strongly predicted sepsis ( P = 0.001 ; odds ratio , 25.1 ; 95 % CI , 5.11 - 123 ) , sensitivity , 46 % ; specificity , 97 % ; positive likelihood ratio , 13 ( 95 % CI , 4.4 - 38 ) ; negative likelihood ratio , 0.57 ( 95 % CI , 0.33 - 0.97 ) . CONCLUSIONS Functional compromise in colorectal cancer surgery is associated with adverse postoperative outcome . Assessment of functional compromise by means of a nutritional question naire ( Short Nutritional Assessment Question naire ) , a frailty question naire ( Groningen Frailty Indicator ) , and sarcopenia measurement ( L3 muscle index ) can accurately predict postoperative sepsis Objective This study aim ed to determine the risk of severe postoperative complications ( SPCs ) in patients with gastric cancer and to construct a nomogram based on independently related factors to identify high-risk patients . Methods We conducted a prospect i ve study of 636 consecutive patients with gastric cancer who underwent radical gastrectomy . Degrees of sarcopenia and obesity were calculated before surgery . Factors contributing to SPCs were determined using univariate and multivariate analysis . A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of SPCs . Results Logistic analysis revealed that sarcopenic obesity , age , open surgery , and combined resection were independent prognostic factors for SPCs . Sarcopenic obese patients have the highest risk in all patients ( sarcopenic obesity vs normal , OR = 6.575 p = 0.001 ; sarcopenic obesity vs obesity , OR = 5.833 p = 0.001 ; sarcopenic obesity vs sarcopenia , OR = 2.571 p = 0.032 ) , while obese patients share the similar rate of SPCs with normal people ( obesity vs normal , OR = 1.056 p = 0.723 ) . The nomogram we constructed was able to quantify the risk of SPCs reliably ( c-index , 0.737 ) . Conclusions Sarcopenic obesity , together with age , open surgery , and combined resection are independent predictors of SPCs . Obesity will significantly increase the risk of SPCs in sarcopenic patient with gastric cancer , but it will not bring higher risk to normal patients . Our nomogram is a simple and practical instrument to identify patients at high risk of surgical complications BACKGROUND A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer . However , the current geriatric assessment has been considered to be either time-consuming or subjective . The present study aim ed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy . MATERIAL S AND METHODS We conducted a prospect i ve study of patients who underwent radical gastrectomy from August 2014 to December 2015 .  Computed tomography-assessed lumbar skeletal muscle , h and grip strength , and gait speed were measured to define sarcopenia . RESULTS Sarcopenia was present in 69 of 240 patients ( 28.8 % ) and was associated with lower body mass index , lower serum albumin , lower hemoglobin , and higher nutritional risk screening 2002 scores . Postoperative complications significantly increased in the sarcopenic patients ( 49.3 % versus 24.6 % , P < 0.001 ) , compared with nonsarcopenic patients . The multivariate analysis demonstrated that sarcopenia ( odds ratio : 2.959 , 95 % CI : 1.629 - 5.373 , P < 0.001 ) and the Charlson comorbidity index ≥2 ( odds ratio : 3.357 , 95 % CI : 1.144 - 9.848 , P = 0.027 ) were independent risk factors for postoperative complications . CONCLUSIONS Sarcopenia , presented as a new geriatric assessment factor , was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer The sustainability of health and social care systems is threatened by a growing population of older persons with heterogeneous needs related to multimorbidity , frailty , and increased risk of functional impairment . Since disability is difficult to reverse in old age and is extremely burdensome for individuals and society , novel strategies should be devised to preserve adequate levels of function and independence in late life . The development of mobility disability , an early event in the disablement process , precedes and predicts more severe forms of inability . Its prevention is , therefore , critical to impede the transition to overt disability . For this reason , the Sarcopenia and Physical fRailty IN older people : multi-componenT Treatment strategies ( SPRINTT ) project is conducting a r and omized controlled trial ( RCT ) to test a multicomponent intervention ( MCI ) specifically design ed to prevent mobility disability in high-risk older persons . SPRINTT is a phase III , multicenter RCT aim ed at comparing the efficacy of a MCI , based on long-term structured physical activity , nutritional counseling/dietary intervention , and an information and communication technology intervention , versus a healthy aging lifestyle education program design ed to prevent mobility disability in 1500 older persons with physical frailty and sarcopenia who will be followed for up to 36 months . The primary outcome of the SPRINTT trial is mobility disability , operationalized as the inability to walk for 400 m within 15 min , without sitting , help of another person , or the use of a walker . Secondary outcomes include changes in muscle mass and strength , persistent mobility disability , falls and injurious falls , disability in activities of daily living , nutritional status , cognition , mood , the use of healthcare re sources , cost-effectiveness analysis , quality of life , and mortality rate . SPRINTT results are expected to promote significant advancements in the management of frail older persons at high risk of disability from both clinical and regulatory perspectives . The findings are also projected to pave the way for major investments in the field of disability prevention in old age Background The association between sarcopenia and postoperative outcomes for patients with gastrointestinal malignancies remains controversial . This study aim ed to assess the impact of sarcopenia on short- and long-term outcomes after surgery for esophagogastric junction cancer ( EGJC ) or upper gastric cancer ( UGC ) . Methods The study review ed 148 patients with EGJC or UGC who underwent surgical resection .  The patients were categorized into the sarcopenia group or the non-sarcopenia group according to their skeletal muscle index calculated using abdominal computed tomography images . The study compared clinicopathologic factors , postoperative complications , and prognosis between the two groups . Results Sarcopenia was present in 19 patients ( 32.2 % ) with EGJC and 23 patients ( 25.8 % ) with UGC . The 5-year overall survival ( OS ) and recurrence-free survival ( RFS ) rates were significantly poorer in the sarcopenia group than in the non-sarcopenia group ( OS 85.5 vs 54.8 % , P = 0.0010 ; RFS 78.7 vs 51.7 % , P = 0.0054 ) . The development of postoperative complications did not differ significantly between the two groups . Both the uni- and multivariate analyses showed that N stage ( P < 0.0001 ) and sarcopenia ( P = 0.0024 and 0.0293 , respectively ) were independent poor prognostic factors for OS . Conclusions Sarcopenia was strongly associated with a poor long-term prognosis for patients with EGJC or UGC who underwent surgery . The results suggest that special attention might be needed during the development of treatment strategies for patients with sarcopenia who intend to undergo operations for EGJC and UGC To determine the prevalence of low skeletal muscle mass in patients undergoing transcatheter aortic valve replacement ( TAVR )  and whether skeletal muscle mass measured from preoperative computed tomography ( CT ) images provides value in predicting postoperative length of stay ( LOS ) . BACKGROUND There are limited data on the use of body composition as a frailty measure in TAVR patients and no studies have determined if this measure predicts LOS . METHODS We studied 104 consecutive patients who underwent TAVR at Tallahassee Memorial Hospital from 2012 to 2016 . Patient demographics , st and ard frailty measures ( h and grip , albumin , and 5-m walk test ) , clinical comorbidities , echocardiographic data , and Valve Academic Research Consortium II major complications were recorded prospect ively . Skeletal muscle index ( SMI ) [ skeletal muscle mass cross-sectional area at L3/height2 ] was measured from CT images using Slice-O-Matic software ( Tomovision , Montreal , Quebec , Canada ) . Clinical outcomes were assessed and multivariate methods used to determine predictors of LOS . RESULTS Sarcopenia was prevalent in men ( 83 % ) and women ( 56 % ) . Patients who suffered from a major complication had significantly longer length of stay ( 13 vs 4.6days , P<.0001 ) . Skeletal muscle index correlated with age , sex , body mass index , h and grip strength , and previous coronary artery bypass graft surgery , but not major complications . A multivariate model including all univariate predictors of LOS showed SMI , major complications , transapical access , atrial fibrillation , and chronic obstructive pulmonary syndrome as independent predictors of LOS . For every 14-cm2/m2 increase in SMI , there was a 1-day reduction in LOS . None of the st and ard measures of frailty predicted LOS . CONCLUSIONS Skeletal muscle index , a measure of sarcopenia readily determined from pre-TAVR CT scans , independently predicts TAVR LOS better than st and ard frailty testing . Further evaluation of SMI as a frailty measure after TAVR and other cardiovascular procedures is warranted Background This study aim ed to determine the relationship between intra-abdominal infection ( IAI ) and sarcopenia prospect ively and to construct a nomogram to identify patients at a high risk of IAI . Methods We conducted a prospect i ve study of 682 consecutive patients with gastric cancer who underwent radical gastrectomy .  The sarcopenia elements , including lumbar skeletal muscle index , h and grip strength , and gait speed , were measured before surgery . Factors contributing to IAI were determined through univariate and multivariate analysis . A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of IAI . Results Of the 682 patients enrolled in this study , 132 patients were diagnosed with sarcopenia and 61 were diagnosed with IAI . Logistic analysis revealed that sarcopenia , tumor size , pathological type , and multivisceral resection were independent prognostic factors for IAI . The nomogram model for IAI was able to reliably quantify the risk of IAI with a strong optimism-adjusted discrimination ( concordance index , 0.736 ) . Conclusions Sarcopenia is an independent predictor of IAI . Our nomogram was a simple and practical instrument to quantify the individual risk of IAI and could be used to identify patients at a high risk Purpose Sarcopenia is distinguished by decreased skeletal muscle plus low muscle strength and /or physical performance . This study was design ed to demonstrate the relationship between sarcopenia and systemic inflammatory response ( neutrophil/lymphocyte ratio [ NLR ] , platelet/lymphocyte ratio [ PLR ] , and large platelet/lymphocyte ratio [ LPLR ] ) prior to radical gastrectomy for gastric cancer . Patients and methods We conducted a prospect i ve study of gastric cancer patients who underwent radical gastrectomy .  The clinical utility of the NLR , PLR , and LPLR was evaluated by receiver operating characteristic curves . Sarcopenia components including skeletal muscle index , h and grip strength , and 6 m usual gait speed were measured . Logistic analysis was used to identify the independent indices associated with sarcopenia . Results A total of 670 patients were included , representing 504 men and 166 women . Of these , 104 patients ( 15.5 % ) were diagnosed with sarcopenia and 567 ( 84.5 % ) were non-sarcopenia . PLR has a diagnostic sensitivity of 91.3 % for sarcopenia . In addition to the indicators of preoperative age , nutritional risk screening , body mass index , preoperative albumin , and diabetes , the NLR and PLR were independent predictors for sarcopenia ( P<0.05 ) . Conclusion The present study showed that at-diagnosis sarcopenia was associated with inflammation in patients with operable gastric cancer . Due to the complex assessment of muscle condition , PLR may be used as a primary screening test for sarcopenia . How systemic inflammatory response influences changes in sarcopenia may provide new therapeutic perception toward improving outcomes Background Sarcopenia is a decrease in both muscle mass and strength . It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery . This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery . Methods A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined . Patients with performance status 3 or 4 were excluded .  Preoperative lean body mass ( LBM ) was evaluated by bioelectrical impedance analysis and expressed as LBM index .  Preoperative muscle function was measured by h and grip strength ( HGS ) . The cutoff values were the gender-specific lowest 20 % . Grade 2 or higher morbidities , as retrospectively evaluated by the Clavien – Dindo classification , were obtained from the patient record . The risk factors for morbidity were examined by univariate and multivariate analyses . Results Morbidity was observed in 39 patients ( 13.3 % ) , including 7 with pancreatic leakage , 12 with anastomotic leakage , and 4 with intraabdominal abscesses , but no mortality was observed . The univariate analysis showed that male gender , total gastrectomy , splenectomy , and a low HGS were significant risk factors for morbidity . A low LBM was not a significant risk factor . A low HGS , male gender , and total gastrectomy remained significant in the multivariate analysis . Conclusions A low h and grip strength was a significant risk factor for morbidity after gastric cancer surgery . The importance of the h and grip strength as a risk factor should be examined in future prospect i ve studies BACKGROUND AND AIMS sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals . We evaluated the impact of sarcopenia on the risk of all-cause death in a population of frail older persons living in community . METHODS we analysed data from the Aging and Longevity Study , a prospect i ve cohort study that collected data on all subjects aged 80 years and older residing in the Sirente geographic area ( n = 364 ) . The present analysis was conducted among those subjects who were between 80 and 85 years of age at the time of the baseline assessment ( n = 197 ) . The main outcome measure was all-cause mortality over 7-year follow-up . According to the European Working Group on Sarcopenia in Older People ( EWGSOP ) criteria , the diagnosis of sarcopenia required the documentation of low muscle mass and the documentation of either low muscle strength or low physical performance . Cox proportional regression models were used to estimate crude and adjusted hazard ratios and 95 % confidence intervals of death by the presence of sarcopenia . RESULTS using the EWGSOP-suggested criteria , 43 subjects with sarcopenia ( 21.8 % ) were identified . During the 7-year follow-up , 29 ( 67.4 % ) participants died among subjects with sarcopenia compared with 63 subjects ( 41.2 % ) without sarcopenia ( P < 0.001 ) . After adjusting for potential confounders including age , gender , education , activities of daily living ( ADL ) impairment , body mass index , hypertension , congestive heart failure , chronic obstructive pulmonary disease , number of diseases , TNF-α , participants with sarcopenia had a higher risk of death for all causes compared with non-sarcopenic subjects ( HR : 2.32 , 95 % CI : 1.01 - 5.43 ) . CONCLUSIONS our results obtained from a representative sample of very old and frail subjects show that sarcopenia is associated with mortality , independently of age and other clinical and functional variables OBJECTIVE The geriatric assessment ( GA ) has proven to be of great value for clinicians treating older patients . However , a clear consensus on the optimal set of GA instruments is lacking , particularly for surgical patients . Therefore , the aim of this prospect i ve study was to compare the prevalence of frailty , depending on the number of incorporated GA domains , and to evaluate its accuracy in predicting postoperative outcome . MATERIAL S AND METHODS Seventy-five patients aged 65 years and older , qualified for abdominal surgery due to solid cancer , were enrolled . The GA included a wide variety of vali date d tools that evaluate functional , mobility , nutritional , co-morbidity , polypharmacy , and psychosocial domains .  RESULTS Depending on the number of incorporated GA domains the frequency of frailty was 23 - 97 % . The cumulative score rather than individual components of the GA , turned out to be an independent risk factor of 30-day postoperative morbidity . In predicting 30-day " any " and " major " morbidities , the area under the curve was 0.67 - 0.72 and 0.70 - 0.82 ( model including the severity of the surgery ) vs. 0.57 - 0.66 and 0.50 - 0.65 ( model not including the severity of the surgery ) , respectively . CONCLUSION The number of incorporated GA domains has a great influence on the prevalence of frailty and on adequate surgical risk assessment . The summary deficit score based on Pre-operative Assessment of Cancer in the Elderly ( PACE ) or the GA consisting of functional , mobility , cognitive , depression , nutritional , co-morbidity , polypharmacy , and social support assessment domains can predict 30-day postoperative morbidity . However , only models with addition of the severity of surgery show moderate to good predictive value Background Frailty is a term commonly used to describe the condition of an older person who has chronic health problems , has lost functional abilities and is likely to deteriorate further . However , despite its common use , only a small number of studies have attempted to define the syndrome of frailty and measure its prevalence . The criteria Fried and colleagues used to define the frailty syndrome will be used in this study ( i.e. weight loss , fatigue , decreased grip strength , slow gait speed , and low physical activity ) . Previous studies have shown that clinical outcomes for frail older people can be improved using multi-factorial interventions such as comprehensive geriatric assessment , and single interventions such as exercise programs or nutritional supplementation , but no interventions have been developed to specifically reverse the syndrome of frailty . We have developed a multidisciplinary intervention that specifically targets frailty as defined by Fried et al. We aim to establish the effects of this intervention on frailty , mobility , hospitalisation and institutionalisation in frail older people . Methods and Design A single centre r and omised controlled trial comparing a multidisciplinary intervention with usual care . The intervention will target identified characteristics of frailty , functional limitations , nutritional status , falls risk , psychological issues and management of chronic health conditions .  Two hundred and thirty people aged 70 and over who meet the Fried definition of frailty will be recruited from clients of the aged care service of a metropolitan hospital . Participants will be followed for a 12-month period . Discussion This research is an important step in the examination of specifically targeted frailty interventions . This project will assess whether an intervention specifically targeting frailty can be implemented , and whether it is effective when compared to usual care . If successful , the study will establish a new approach to the treatment of older people at risk of further functional decline and institutionalisation . The strategies to be examined are readily transferable to routine clinical practice and are applicable broadly in the setting of aged care health services . Trial Registration Australian New Zeal and Clinical Trails Registry : ACTRN12608000250336 BACKGROUND The clinical syndrome of frailty identified through the assessment of weight loss , gait speed , grip strength , physical activity , and physical exhaustion has been used to identify patients with reduced reserves . We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients . METHODS A prospect i ve study was conducted at 2 centers ( Singapore and Japan ) . All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty .  All these patients had already had their comorbidities optimized for surgery . The outcome measure was postoperative major complications ( defined as Clavien-Dindo type II and above complications ) . RESULTS Eighty-three patients were studied from February 2008 to April 2010 . The mean age was 81.5 years ( range 75 - 93 years ) . The mean comorbidity index was 3.37 ( range 0 - 11 ) . Twenty-six ( 31.3 % ) patients were an American Society of Anesthesiologists ( ASA ) score of 3 and above . Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 ( 95 % confidence interval , 1.433 - 11.638 ) when the patient satisfied the criteria for frailty . Albumin < 35 , ASA > 3 , comorbidity index > 5 , and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity ( POSSUM ) scores were not predictive of postoperative major complications . CONCLUSIONS Preliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity . Frailty can be used to identify elderly patients needing further optimization before major surgery INTRODUCTION Ovarian cancer is the leading cause of death among gynecological malignancies . Its usual clinical manifestation is at advanced stages , with nutritional impairment , weight loss , and a consequent decline in skeletal muscle mass and strength ( defined as sarcopenia ) . The relationship between sarcopenia and decreased survival was demonstrated not only in ovarian cancer but also in other cancer types , such as hepatocellular , pancreatic , lung , colon , cervical , metastatic breast , and renal cancer . The aim of this study is to review the current evidence regarding the relationship between sarcopenia and the surgical and oncological outcomes in ovarian cancer patients . METHODS The systematic search was performed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRSIMA ) statement . The terms " SARCOPENIA " AND " OVARIAN CANCER " were systematic ally used to search PubMed and Scopus data bases . Original reports in English language were identified , with the purpose to include all relevant papers regarding the role of sarcopenia and indicators of skeletal muscle quality assessment in gynecological ovarian cancer . RESULTS A total of 9 studies were considered eligible for the present review . The strength of recommendation was moderate and the level of evidence was low in all selected articles . No prospect i ve studies were conducted and most of the papers were case-control series comparing ovarian cancer sarcopenic population vs. non sarcopenic population . CONCLUSIONS Sarcopenia appears to have an important role in oncological outcomes of ovarian cancer patients . However , sarcopenia occurrence during disease history and mechanisms underlying the possible impairment in prognosis should be better investigated . Prospect i ve trials are awaited in order to obtain a better insight in this topic Background Laparoscopy-assisted surgery with extraperigastric lymph node dissection for gastric cancers has been described , but the clinical benefits of these surgeries still are unclear . Short-term clinical outcomes were compared between laparoscopy-assisted distal gastrectomy ( LADG ) and conventional open distal gastrectomy ( ODG ) for early gastric cancer in a prospect i ve r and omized fashion . Methods For this study , 28 patients with early gastric cancers in the lower half of the stomach were r and omly assigned to either LADG ( n = 4 ) or ODG ( n = 14 ) . Postoperative pain , levels of acute inflammatory responses , and pathologic evaluation of the operative specimens were compared . Results The LADG group required a significantly shorter period of postoperative epidural anesthesia , showed significantly lower levels of serum interleukin-6 and C-reactive protein , and had no major postsurgery complications . Pathologic examinations showed that surgery was equally radical in the two groups . Conclusion The findings show that LADG with extraperigastric lymph node dissection is a safe and less invasive alternative to the open procedure Abstract Background : The extent of st and ard lymph node dissection ( D1 , D2 , or D3 ) in gastric cancer patients is still controversial . Several prospect i ve European trials attained contradictory results . A generally increased body mass index ( BMI ) of the European patients was assumed to be one of the major causes for postoperative morbidity . Methods : We evaluated the effect of BMI on the quality of routine D2 lymph node dissection and on postoperative morbidity in patients with gastric cancer who underwent a potentially curative total gastrectomy . A total of 199 consecutive gastric cancer patients who underwent a total gastrectomy and a routine D2 lymph node dissection between 1992 and 2001 were included in the study . According to BMI , they were assigned to three groups : group A , with BMI < 25 kg/m2 ( normal body weight ) ; group B , with BMI of 25 to 30 kg/m2 ( overweight ) ; and group C , with BMI > 30 kg/m2 ( obesity ) . Parameters such as complete histopathological staging , intraoperative blood loss , length of operation , and surgical and nonsurgical morbidity were recorded and correlated within the different groups . Results : No significant differences were found with regard to the number of examined lymph nodes , blood loss , length of operation , surgical complications , or length of stay in the intensive care unit . Conclusions : In contrast to comparable Japanese studies , our analysis reveals that even for overweight patients , a st and ard D2 lymph node dissection is justified without significantly increased morbidity Splenectomy is often performed in patients who undergo total gastrectomy for cancer of the upper stomach . Although splenectomy facilitates lymph node dissection of the splenic hilum and recent reports advocate spleen preservation , the role of the spleen is not fully eluci date d in gastric cancer treatment . This prospect i ve r and omized study was performed to evaluate the role of the spleen in immunological function in gastric cancer patients who underwent total gastrectomy and received postoperative immunochemotherapy . Forty-five patients with gastric cancer were r and omly allocated to four groups : 1 . splenectomy without immunotherapy ( OK-432 administration ) , 2 . splenectomy with immunotherapy , 3 . spleen preservation without immunotherapy , 4 . spleen preservation with immunotherapy .  Postoperative immunological function of these patients was compared among the four groups . NK cell activity of the peripheral blood lymphocytes ( PBL ) in spleen-preserved patients who received immunotherapy was significantly higher for 24 weeks after surgery than that of the splenectomized patients with and without OK-432 administration . IL-2 production of PBL in spleen-preserved patients with immunotherapy was significantly higher between 4 and 24 weeks after surgery compared with that of the splenectomized patients without immunotherapy . The results suggest that spleen preservation might be beneficial in patients with less advanced gastric cancer who receive postoperative immunochemotherapy after total gastrectomy BACKGROUND Computed tomography ( CT ) can be used for accurate estimation of whole-body muscle mass and muscle density and for detection of sarcopenia . The goal of this study was to evaluate the additional value of CT measured sarcopenia and muscle attenuation alongside the Malnutrition Universal Screening Tool ( MUST ) for the prediction of post-operative morbidity after oncological colorectal resection , whilst correcting for known risk factors . METHODS A prospect i ve cohort study of 80 patients undergoing elective colorectal surgery in the Netherl and s. Patients were screened for nutritional risk upon admission using the MUST . Additionally , preoperative CT scans were used to determine skeletal muscle mass for the detection of sarcopenia and muscle attenuation . Univariate and multivariable analyses were performed to evaluate associations between the MUST , muscle attenuation and sarcopenia on the one h and and post-operative complications measured by the Clavien-Dindo score on the other h and . RESULTS American Society of Anesthesiology-classification ( ASA ) ≥3 , age ≥70 , MUST ≥2 and lower than median muscle attenuation were significantly associated with a higher risk for postoperative complications ( Clavien-Dindo score ≥2 ) ( p ≤ 0.05 ) , whereas sarcopenia was not ( p = 0.59 ) . Multivariate analyses showed that only MUST ≥2 remained significantly associated with postoperative complications when corrected for age ( p = 0.03 , OR 5.8 , 95%CI 1.1 - 29.6 ) , but not when corrected for age ≥70 and ASA ≥3 . Muscle attenuation and sarcopenia were not significantly associated with postoperative complications . CONCLUSION Our results suggest that using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery . It also underlines the importance of currently implemented easy-to-use nutritional screening tools ( MUST ) and raises the question of the evaluation of muscle quality versus quantity in body composition imaging . However , further research is needed to investigate the role of sarcopenia for predicting outcome after colorectal surgery , and investigate the role of muscle attenuation measurements for the prediction of muscle function . CATEGORY OF SU BMI SSION : observational study
ConclusionS arcopenia and frailty seem to have significant adverse impacts on the occurrence of postoperative outcomes .
Background Gastric cancer is a major health problem , and frailty and sarcopenia will affect the postoperative outcomes in older people .
However , there is still no systematic review to determine the role of frailty and sarcopenia in predicting postoperative outcomes among older patients with gastric cancer who undergo gastrectomy surgery .