James Bundred1, Sivesh K Kamarajah2, Keith J Roberts3. 1. College of Medical and Dental Sciences, University of Birmingham, United Kingdom. 2. Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, Newcastle, United Kingdom; Institute of Cellular Medicine, University of Newcastle, Newcastle, United Kingdom. 3. University of Birmingham and Consultant Surgeon Queen Elizabeth Hospital Birmingham, United Kingdom. Electronic address: j.k.roberts@bham.ac.uk.
Abstract
BACKGROUND: Numerous studies have suggested an association between sarcopenia in pancreatic cancer and adverse outcomes. This systematic review examines the evidence for the impact of sarcopenia on post-operative complications and survival METHODS: A systematic literature search was conducted to identify randomised and non-randomised studies of sarcopenia in pancreatic cancer. Meta-analyses of intra- and post-operative outcomes were performed (operating time, all complications, major complications, pancreatic fistulae, peri-operative mortality, overall survival). RESULTS: Forty-two studies reported the assessment of body composition in 7619 patients. Methods used to assess body composition in patients with pancreatic cancers were computerized tomography (n = 34), bioelectrical impedance analysis (n = 7), and dual-energy-X-ray-absorptiometry (n = 1). Only 10 studies reported the impact of pre-operative sarcopenia upon post-operative outcomes. Sarcopenia was associated with increased peri-operative mortality (OR: 2.40, CI95%:1.19-4.85, p < 0.01) and decreased overall survival by univariable (HR: 1.95, CI95%:1.35-2.81, p < 0.001) and multivariable analysis (HR: 1.78, CI95%:1.54-2.05). Sarcopenia was not significantly associated with all complications (OR: 0.96, CI95%:0.78-1.19) or pancreatic fistula (OR: 0.95, CI95%: 0.59-1.54). CONCLUSIONS: Assessment of sarcopenia in pancreatic cancer provides prognostic value but, more importantly, may provide a basis for therapeutic intervention. However, variation in the methods of assessing and reporting sarcopenia in this patient group limits the assessment of post-operative outcomes currently.
BACKGROUND: Numerous studies have suggested an association between sarcopenia in pancreatic cancer and adverse outcomes. This systematic review examines the evidence for the impact of sarcopenia on post-operative complications and survival METHODS: A systematic literature search was conducted to identify randomised and non-randomised studies of sarcopenia in pancreatic cancer. Meta-analyses of intra- and post-operative outcomes were performed (operating time, all complications, major complications, pancreatic fistulae, peri-operative mortality, overall survival). RESULTS: Forty-two studies reported the assessment of body composition in 7619 patients. Methods used to assess body composition in patients with pancreatic cancers were computerized tomography (n = 34), bioelectrical impedance analysis (n = 7), and dual-energy-X-ray-absorptiometry (n = 1). Only 10 studies reported the impact of pre-operative sarcopenia upon post-operative outcomes. Sarcopenia was associated with increased peri-operative mortality (OR: 2.40, CI95%:1.19-4.85, p < 0.01) and decreased overall survival by univariable (HR: 1.95, CI95%:1.35-2.81, p < 0.001) and multivariable analysis (HR: 1.78, CI95%:1.54-2.05). Sarcopenia was not significantly associated with all complications (OR: 0.96, CI95%:0.78-1.19) or pancreatic fistula (OR: 0.95, CI95%: 0.59-1.54). CONCLUSIONS: Assessment of sarcopenia in pancreatic cancer provides prognostic value but, more importantly, may provide a basis for therapeutic intervention. However, variation in the methods of assessing and reporting sarcopenia in this patient group limits the assessment of post-operative outcomes currently.
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