Preoperative low skeletal muscle mass index assessed using L3-CT as a prognostic marker of clinical outcomes in pancreatic cancer patients undergoing surgery: A systematic review and meta-analysis

Pauline Raoul; Marco Cintoni; Alessandro Coppola; Sergio Alfieri; Giampaolo Tortora; Antonio Gasbarrini; Maria Cristina Mele; Emanuele Rinninella

doi:10.1097/JS9.0000000000000989

Preoperative low skeletal muscle mass index assessed using L3-CT as a prognostic marker of clinical outcomes in pancreatic cancer patients undergoing surgery: A systematic review and meta-analysis

Int J Surg. 2023 Dec 11;110(10):6126-6134. doi: 10.1097/JS9.0000000000000989. Online ahead of print.

Authors

Pauline Raoul¹, Marco Cintoni^{1

2}, Alessandro Coppola³, Sergio Alfieri^{4

5}, Giampaolo Tortora^{4

6}, Antonio Gasbarrini^{2

4

7}, Maria Cristina Mele^{1

2

4}, Emanuele Rinninella^{1

2

4}

Affiliations

¹ Unità operativa di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino Metaboliche; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
² Centro di Ricerca in Nutrizione Umana, Università Cattolica del Sacro Cuore, Rome, Italy.
³ Dipartimento di Scienze Chirurgiche, Università di Roma La Sapienza, Rome, Italy.
⁴ Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵ Unità operativa di Chirurgia Addominale, Dipartimento di Scienze Mediche e Chirurgiche Endocrino Metaboliche; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Unità operativa di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino Metaboliche; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁷ Centro Malattie Apparato Digerente (CEMAD), Dipartimento di Scienze Mediche e Chirurgiche Endocrino Metaboliche; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Abstract

Background: Reduction in muscle mass can be routinely quantified using computed tomography (CT) of the third lumbar vertebra (L3) during a curative pancreatic cancer (PC) course. This systematic review and meta-analysis aimed to assess the association between preoperative low skeletal muscle index (SMI) measured by L3 CT and postoperative clinical outcomes in PC resectable patients.

Methods: Three electronic databases (PubMed, Web of Science, and Scopus) were searched for articles published through May 2023. Duplicate titles and abstracts, full-text screening, and data extraction were performed. A meta-analysis was performed for overall survival (OS), recurrence-free survival (RFS), postoperative pancreatic fistula (POPF), morbidity, and postoperative length of stay (P-LOS). The risk of bias was assessed.

Results: A total of 2942 patients with PC from 11 studies were identified. Preoperative low SMI was found in 50.9% of PC resectable patients. Preoperative low SMI was significantly associated with adjusted OS (adjusted HR, 1.52; 95% CI 1.25-1.86, P< 0.0001). No significant associations were found between preoperative low SMI and RFS, number of POPF, significant morbidity, and P-LOS (P>0.05).

Conclusions: SMI should be evaluated in a timely manner as a predictor of OS in PC resectable patients. Studies assessing nutritional protocols for maintaining/increasing skeletal muscle mass are required to develop a personalized nutritional approach to improve clinical outcomes.