Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy

Abstract

Background and Aim

Sarcopenia has been proven to be a risk factor after pancreatoduodenectomy (PD). We aimed to evaluate if decreased psoas muscle area and density shown in CT scan, as measures for sarcopenia, were associated with postoperative major complications and adverse outcomes in patients who underwent PD.

Patients and Methods

We analyzed 152 consecutive patients who underwent open PD. Total psoas area and muscle attenuation were measured on CT images at the level of the third lumbar vertebra. Total psoas area index (TPAI) was calculated, the cut-off values of TPAI were estimated and validated. The relationship between radiographic characters and outcomes was analyzed.

Results

The optimal cut-off values of TPAI were 4.78 cm²/m² for males and 3.46 cm²/m² for females. The values were validated by outcomes with significant differences in the rate of major complications, re-operation, length of stay, and total cost. The prevalence of TPAI-defined sarcopenia and sarcopenic overweight/obesity was 38.8% and 17.1% in total. In multivariate logistic regression, rate of major complications was associated with TPAI [OR=0.605, 95% CI (0.414, 0.883), P=0.009], TPAI-defined sarcopenia [OR=8.256, 95% CI (2.890, 23.583), P=0.000] and sarcopenic overweight/obesity [OR=7.462, 95% CI (2.084, 26.724), P=0.002]; meanwhile, NRS2002-defined nutritional risk and GLIM-defined malnutrition did not show relationship with major complications.

Conclusion

Both sarcopenia and sarcopenic overweight/obesity determined by new TPAI cut-off values were associated with a higher rate of major complications and adverse outcomes in Chinese patients undergoing open PD whereas usual nutritional assessment was not.

Keywords:

• psoas muscle area index
• CT scan
• sarcopenia
• sarcopenic obesity
• pancreatoduodenectomy

Acknowledgments

We would like to thank all individuals who participated in this study and the nursing staff for their assistance in the data collection.

Disclosure

The authors declare that the article is original, is not under consideration for publication anywhere else and has not been previously published. The authors declare no conflicts of interest, or financial disclosures.

Additional information

Funding

This work was supported in part by the Clinical Research Projects Supported by Beijing Municipal Science & Technology Commission (No. Z181100001718216 for JY Xu).