虚弱和肌肉减少对老年人肝胆胰根治性手术术后并发症的联合影响

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2024-12-24 DOI:10.1002/ags3.12897

Norifumi Harimoto, Keishi Sugimachi, Tomohiro F. Nishijima, Tomino Takahiro, Tomonari Shimagaki, Yohei Mano, Emi Onishi, Masahiko Sugiyama, Yasue Kimura, Masaru Morita

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引用次数: 0

摘要

目的老年癌症患者在大手术后发生术后并发症的风险往往会增加。本研究旨在评估虚弱和肌肉减少症在预测高龄肝胆癌和胰腺癌手术后并发症中的联合作用。方法本回顾性研究纳入107例日本患者，这些患者在癌症治疗决定和随后的肝胆癌和胰腺癌的治愈性手术前接受了老年肿瘤学服务的综合老年评估（CGA）。使用基于CGA （FI-CGA-10）的验证的10项虚弱指数来测量虚弱状态，并将其分类为健康、虚弱或虚弱。使用生物电阻抗分析和握力评估肌肉减少症。主要终点是术后并发症，定义为Clavien-Dindo分级≥III，手术1个月内。结果107例患者中位年龄79岁（75 ~ 89岁）。患者分为健康（n = 36, 33.7%）、体弱（n = 57, 53.2%）和体弱（n = 14, 13.1%）。其中，21名患者（20%）被诊断为肌肉减少症；16例（15%）患者出现术后并发症。体弱或体弱患者的术后并发症发生率高于健康患者（19.7% vs 5.6%, p = 0.08）。体弱或体弱和肌肉减少的患者术后并发症的风险明显更高。这种关联在多变量模型中仍然显著(OR 4.74；95% ci, 1.10-20.29；p = 0.04)。结论在本研究中，体弱/体弱和肌肉减少的患者术后并发症的风险明显更高。

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Combined effect of frailty and sarcopenia on postoperative complications in older adults undergoing curative surgery for hepato-biliary-pancreatic cancer

Aim

Older adults with cancer are often at increased risk for postoperative complications following major surgeries. This study aimed to evaluate the combined role of frailty and sarcopenia in predicting postoperative complications in older adults with hepatobiliary and pancreatic cancer undergoing surgery.

Methods

This retrospective study included 107 Japanese patients who underwent comprehensive geriatric assessment (CGA) at the geriatric oncology service before cancer treatment decisions and subsequent curative surgery for hepatobiliary and pancreatic cancer. Frailty status was measured using the validated 10-item frailty index based on a CGA (FI-CGA-10) and categorized as fit, prefrail, or frail. Sarcopenia was assessed using bioelectrical impedance analysis and grip strength. The primary outcome was postoperative complications, defined as Clavien–Dindo grade ≥ III, within 1 month of surgery.

Results

The median age of the 107 patients was 79 (range, 75–89) years. Patients were categorized as fit (n = 36, 33.7%), prefrail (n = 57, 53.2%), or frail (n = 14, 13.1%). Of these, 21 patients (20%) were diagnosed with sarcopenia; 16 patients (15%) experienced postoperative complications. Patients classified as prefrail or frail had a higher incidence of postoperative complications compared with those classified as fit (19.7% vs. 5.6%, p = 0.08). Patients with both prefrail or frail and sarcopenia had a significantly higher risk of postoperative complications. This association remained significant in the multivariable model (OR 4.74; 95% CI, 1.10–20.29; p = 0.04).