Key Factors for Maintaining Postoperative Skeletal Muscle Mass After Laparoscopic Proximal Gastrectomy with Double-Flap
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RESEARCH COMMUNICATION
Key Factors for Maintaining Postoperative Skeletal Muscle Mass After Laparoscopic Proximal Gastrectomy with Double-Flap Technique Reconstruction for Early Gastric Cancer Motonari Ri 1 & Souya Nunobe 1 & Rie Makuuchi 1 & Satoshi Ida 1 & Koshi Kumagai 1 & Manabu Ohashi 1 & Takeshi Sano 1 Received: 18 June 2020 / Accepted: 27 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Laparoscopic proximal gastrectomy . Esophagogastrostomy . Double flap technique . Skeletal muscle . Remnant stomach volume . Complication
Introduction For upper third gastric cancer diagnosed at an early stage, laparoscopic proximal gastrectomy (LPG) is advocated as a function-preserving procedure.1 The double-flap technique (DFT), one of the post-LPG reconstruction methods, is a preferable procedure based on preventing reflux via valve formation and the physiological benefits of esophagogastrostomy. However, several issues regarding skeletal muscle changes having a major impact on the patient’s postoperative activity after LPG-DFT have yet to be clarified. The objective of this study is to examine skeletal muscle mass changes and identify risk factors for decreased skeletal muscle after LPG-DFT.
remnant gastric volume after operation based on the localization of clips. When the distal clips were recognized within the upper region of the stomach in static images, the postoperative residual stomach size was defined as an adequate volume. The total skeletal muscle, including the psoas, paraspinal, and abdominal wall muscles, was measured at the level of the third lumbar vertebra using a SYNAPSE VINCENT Volume Analyzer (Fujifilm Medical Co., Japan). Then, the skeletal muscle index (SMI) was obtained by dividing the cross-sectional area of skeletal muscle by the square of the height. Statistical analyses were conducted using the MannWhitney U test, and multiple logistic regression analysis was performed to estimate independent risk factors for SMI reduction. A p value less than 0.05 was considered to be statistically significant.
Methods From January 2013 to December 2017, patients who underwent LPG-DFT with R0 for early upper third gastric cancer at Cancer Institute Hospital, Tokyo, Japan, were registered. LPG-DFT was performed as previously reported.2 For evaluation of the appropriate indication for LPG, marking clips by endoscopy were placed at the oral and the anal side of the tumor preoperatively, and then fluoroscopy with barium or gastrografin was performed to assess the * Souya Nunobe [email protected] 1
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
Results In total, 158 patients underwent LPG-DFT for upper third gastric cancer (Table 1). The median SMI reduction before and 1 year after the operation was 6.3%. Patients with BMI ≥ 25 (p = 0.02), inadequate gastric remnant volume (p < 0.01), and postoperative complications (p < 0.01) were significantly associated with SMI re
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