Body composition after treatment of intra-mucosal gastric cancer with endoscopic resection compared to gastrectomy.

Background: Patients who undergo gastrectomy may experience changes in their body composition, which may in turn affect survival. However, whether endoscopic resection differs from gastrectomy in its effect on body composition remains unclear.

Methods: This retrospective study included 2267 patients who received either gastrectomy or endoscopic resection for intramucosal gastric cancer. Transverse images at the L3 vertebra level of the patient's staging and follow-up CTs were segmented for the measurement of fat and skeletal muscle areas. In 1134 patients who were propensity score-matched, as well as in all 2267 patients, gastrectomy vs. endoscopic resection was compared in terms of the percentage change in skeletal muscle, visceral fat, subcutaneous fat, and the proportion of newly developed sarcopenia.

Results: Changes in skeletal muscle, visceral fat, and subcutaneous fat are all greater following gastrectomy (p value < 0.001 for all). The change in skeletal muscle is -2.9 % (-3.4%, 2.3%) and 0.3% (-0.2%, 0.8%) following gastrectomy and endoscopic resection, respectively. The change in visceral fat is -50.2 % (-54.1%, -46.3%) and 8.6% (1.7%, 15.6%), respectively. The change in subcutaneous fat is -26.5% (-30.4%, -22.5%) and 3.9% (-0.3%, 8.0%), respectively. The proportion of newly developed sarcopenia is also higher following gastrectomy (1.9% vs. 3.4%), although the difference was not significant. The results are also consistently observed for all patients, regardless of propensity score-matching.

Conclusions: Change in body composition is greater after gastrectomy than after endoscopic resection. Such knowledge may contribute to refining the criteria for treatment selection between gastrectomy and endoscopic resection in patients with intra-mucosal gastric cancer.