Cachexia and its impact on early postoperative results in patients with resectable gastric cancer

   Background: Gastric cancer (GC) is one of the most common malignancies which requires aggressive combined treatment with a high incidence of complications. The search for modifiable risk factors or predictors of complications’ development is ongoing.

   We aimed to investigate the prognostic value of cachexia in patients with resectable GC.

   Materials and methods: A multi-center retro-prospective cohort study included data of 144 GC patients who underwent potentially curative gastrectomy between 2019 and 2023. Cachexia and sarcopenia were diagnosed according to the most recent consensus definitions. Сachexia was defined according to the international consensus criteria as the loss of ≥ 5 % of weight in 6 months or the loss of 2 % body weight in the presence of sarcopenia or BMI < 20 kg / m². To assess the presence of sarcopenia we used Prado criteria (52.4 cm² / m² for men and 38.5 cm² / m² for women) and Martin criteria (41 cm² / m² for women and 43 cm2 / m2 for men with a BMI < 25 kg / m² and 53 cm² / m² with a BMI > 25 kg / m²) for L3 skeletal-muscle index. The 30-day incidence of postoperative complications and 90-day mortality were evaluated.

   Results: There were 57 (39.5 %) patients with cachexia. Cachexia was more prevalent in patients with TNM stage III (42.1 % vs 24.1 %, p = 0.023) and sarcopenic patients (measured by skeletal muscle mass, 49.1 % vs. 18.3 %, p < 0.001, as well as dynamometry, 14.3 % vs. 0 %, p = 0.006). Multivariate analysis revealed that cachexia was a significant predictor of postoperative complications (ОR = 2.208, 95 % CI 1.051–4.638, p = 0.036) and surgical site infection (OR = 3.916, 95 % CI 1.146–13.3874, p = 0.029). The 90-day mortality rate was higher among patients with cachexia (10.5 % vs. 2.3 %, p = 0.039).

   Conclusion: Preoperative cachexia is a potentially modifiable predictor of complications after gastric cancer surgery which may help to identify high-risk patients for proactive multimodal рrehabilitation.

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