PDF(Pubmed)
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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
摘要：
背景：肌肉减少症是一种以骨骼肌质量和力量逐渐广泛减少为特征的综合征，以及功能能力的下降，这与营养不良有关，荷尔蒙的变化,慢性炎症，肠道菌群紊乱，和锻炼质量。胰十二指肠切除术是一种常用的临床干预措施，用于治疗胰头癌等疾病，Vater癌壶腹,和胆管癌,其中,术后并发症发生率明显较高。在接受胰十二指肠切除术的患者中，肌肉减少症很常见。然而,关于接受胰十二指肠切除术(PD)的患者中肌肉减少症的影响的数据既有限又不一致.
目的：评估肌少症对PD患者预后的影响。
方法：PubMed，科克伦图书馆,WebofScience,我们对Embase数据库进行了筛选,筛选了从数据库开始到2023年6月发表的研究,这些研究描述了肌少症对PD结局和并发症的影响.两名研究人员独立评估了从符合纳入标准的研究中提取的数据的质量。采用RevMan5.3.5和Stata14.0软件进行Meta分析。使用了森林和漏斗地块，分别,显示肌肉减少症组与非肌肉减少症组在PD后的结局,并评估潜在的发表偏倚.
结果：荟萃分析中纳入了16项研究，包括2381名患者。肌肉减少症患者（n=833）术后总并发症发生率较高[比值比（OR）=3.42，95％置信区间（CI）：1.95-5.99，P<0.0001]，Clavien-Dindo级别≥III级主要并发症发生率较高（OR=1.41，95CI：1.04-1.90，P=0.03），菌血症发生率较高(OR=4.46,95CI:1.42-13.98,P=0.01),肺炎发生率较高（OR=2.10，95CI：1.34-3.27，P=0.001），胰瘘发生率较高(OR=1.42,95CI:1.12-1.79,P=0.003),住院时间延长（OR=2.86，95CI：0.44-5.28，P=0.02），较高的死亡率（OR=3.17，95CI：1.55-6.50，P=0.002），总生存期(风险比=2.81,95CI:1.45-5.45,P=0.002)比非肌肉减少组(n=1548)差。然而,在伤口感染方面没有观察到显著的组间差异，尿路感染,胆道瘘,或术后消化道出血.
结论：肌肉减少症是PD患者常见的合并症。术前肌肉减少症患者的并发症和死亡率增加，此外，PD后总体生存率较差，住院时间较长。
目的：评估肌少症对PD患者预后的影响。
方法：PubMed，科克伦图书馆,WebofScience,我们对Embase数据库进行了筛选,筛选了从数据库开始到2023年6月发表的研究,这些研究描述了肌少症对PD结局和并发症的影响.两名研究人员独立评估了从符合纳入标准的研究中提取的数据的质量。采用RevMan5.3.5和Stata14.0软件进行Meta分析。使用了森林和漏斗地块，分别,显示肌肉减少症组与非肌肉减少症组在PD后的结局,并评估潜在的发表偏倚.
结果：荟萃分析中纳入了16项研究，包括2381名患者。肌肉减少症患者（n=833）术后总并发症发生率较高[比值比（OR）=3.42，95％置信区间（CI）：1.95-5.99，P<0.0001]，Clavien-Dindo级别≥III级主要并发症发生率较高（OR=1.41，95CI：1.04-1.90，P=0.03），菌血症发生率较高(OR=4.46,95CI:1.42-13.98,P=0.01),肺炎发生率较高（OR=2.10，95CI：1.34-3.27，P=0.001），胰瘘发生率较高(OR=1.42,95CI:1.12-1.79,P=0.003),住院时间延长（OR=2.86，95CI：0.44-5.28，P=0.02），较高的死亡率（OR=3.17，95CI：1.55-6.50，P=0.002），总生存期(风险比=2.81,95CI:1.45-5.45,P=0.002)比非肌肉减少组(n=1548)差。然而,在伤口感染方面没有观察到显著的组间差异，尿路感染,胆道瘘,或术后消化道出血.
结论：肌肉减少症是PD患者常见的合并症。术前肌肉减少症患者的并发症和死亡率增加，此外，PD后总体生存率较差，住院时间较长。
