Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1857-1870
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1857
Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis
Qi-Hui Zhang, Jin-Dong Ma, Yan-Min Lu, Run-Nan Zhang, Zhong-Hua Zhao, Ya-Tong Li, Qiang-Pu Chen
Qi-Hui Zhang, Jin-Dong Ma, Yan-Min Lu, Run-Nan Zhang, Qiang-Pu Chen, Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
Zhong-Hua Zhao, Ya-Tong Li, Qiang-Pu Chen, Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
Co-first authors: Qi-Hui Zhang and Jin-Dong Ma.
Author contributions: Zhang QH and Ma JD contributed equally to this work and are co-first authors. Zhang QH, Ma JD, Lu YM, Zhang RN, and Zhao ZH participated in the data curation; Zhang QH, Ma JD, Lu YM, Zhang RN, Zhao ZH, Li YT, and Chen QP were involved in the writing - review and editing; Zhang QH and Ma JD contributed to the software, validation, and writing - original draft of this manuscript; Lu YM and Chen QP took part in conceptualization and supervision; Zhang QH was involved in the methodology of this study.
Supported by the Shandong Province Biliary Pancreatic Cancer Clinical Quality Specialty Construction Fund, No. SLCZDZK-2401; and Provincial Key Clinical Discipline Construction Fund of Shandong Province, No. SLCZDZK-0701.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiang-Pu Chen, MM, Chief Doctor, Professor, Surgeon, Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, 2nd Huanghe Road, Binzhou 256603, Shandong Province, China. drcqp@263.net
Received: January 22, 2024
Revised: April 14, 2024
Accepted: April 28, 2024
Published online: June 27, 2024
Processing time: 159 Days and 17.3 Hours
Abstract
BACKGROUND

Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength, as well as a decline in functional ability, which is associated with malnutrition, hormonal changes, chronic inflammation, disturbance of intestinal flora, and exercise quality. Pancreatoduodenectomy is a commonly employed clinical intervention for conditions such as pancreatic head cancer, ampulla of Vater cancer, and cholangiocarcinoma, among others, with a notably high rate of postoperative complications. Sarcopenia is frequent in patients undergoing pancreatoduodenectomy. However, data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy (PD) are both limited and inconsistent.

AIM

To assess the influence of sarcopenia on outcomes in patients undergoing PD.

METHODS

The PubMed, Cochrane Library, Web of Science, and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD. Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria. Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted. Forest and funnel plots were used, respectively, to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias.

RESULTS

Sixteen studies encompassing 2381 patients were included in the meta-analysis. The patients in the sarcopenia group (n = 833) had higher overall postoperative complication rates [odds ratio (OR) = 3.42, 95% confidence interval (CI): 1.95-5.99, P < 0.0001], higher Clavien-Dindo class ≥ III major complication rates (OR = 1.41, 95%CI: 1.04-1.90, P = 0.03), higher bacteremia rates (OR = 4.46, 95%CI: 1.42-13.98, P = 0.01), higher pneumonia rates (OR = 2.10, 95%CI: 1.34-3.27, P = 0.001), higher pancreatic fistula rates (OR = 1.42, 95%CI: 1.12-1.79, P = 0.003), longer hospital stays (OR = 2.86, 95%CI: 0.44-5.28, P = 0.02), higher mortality rates (OR = 3.17, 95%CI: 1.55-6.50, P = 0.002), and worse overall survival (hazard ratio = 2.81, 95%CI: 1.45-5.45, P = 0.002) than those in the non-sarcopenia group (n = 1548). However, no significant inter-group differences were observed regarding wound infections, urinary tract infections, biliary fistulas, or postoperative digestive bleeding.

CONCLUSION

Sarcopenia is a common comorbidity in patients undergoing PD. Patients with preoperative sarcopenia have increased rates of complications and mortality, in addition to a poorer overall survival rate and longer hospital stays after PD.

Keywords: Pancreaticoduodenectomy; Sarcopenia; Postoperative complications; Length of stay; Meta-analysis

Core Tip: Muscle wasting has a significant impact on the clinical outcomes and prognosis of patients undergoing major surgery, but there is limited research on the impact of muscle wasting on patients undergoing pancreaticoduodenectomy (PD), and the conclusions are inconsistent. This article aims to evaluate the impact of sarcopenia on the clinical outcomes of PD patients through meta-analysis, in order to provide evidence-based management for PD patients during the perioperative period. Strictly screen articles based on pre-set inclusion and exclusion criteria.