Impact of sarcopenia and muscle strength on postoperative complication risk following pancreatic resection

Background and aims
The association between sarcopenia and postoperative complications has been widely reported in patients with cancer. Yet, the lack of standardized population-specific diagnostic cut-off points and assessments of muscle strength is hampering prospective clinical utilization. Therefore, we aimed to examine the impact of sarcopenia, defined by both regional and international cut-off points, along with various methods of measuring skeletal muscle and muscle strength, on the risk of postoperative complications following pancreatic resection.
Methods
The present prospective observational study enrolled patients scheduled for pancreatic resection. Body composition was assessed by DXA and CT prior to surgery. We applied the algorithm and cut-off points suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) as well as cut-off points from a Danish normative reference population to classify patients as sarcopenic. Physical performance was assessed by usual gait speed while muscle strength was assessed by handgrip strength, leg extensor power, and 30-s sit-to-stand. Postoperative complications within 30 days following surgery were classified according to the Clavien-Dindo classification and the American College of Surgeons National Surgical Quality Improvement Program. Complications graded ≥3 according to Clavien-Dindo were considered major complications.
Results
A total of 134 patients with a mean age of 67 years (SD: 9) were enrolled of whom most underwent pancreaticoduodenectomy (64 %). Using international cut-off points, eight patients (7 %) were classified as sarcopenic using CT scans and sarcopenia was associated with an increased risk of major postoperative complications (RR 2.14 [1.33–3.43]). Using DXA, four patients (3 %) were classified as sarcopenic, all of whom experienced a major complication. With regional cut-off points, 16 patients (13 %) were classified as sarcopenic using CT scans, but sarcopenia was not associated with major complications (RR 1.39 [0.80–2.42]). Nine patients (7 %) were classified as sarcopenic using DXA, but sarcopenia was not associated with major complications (RR 1.15 [0.54–2.48]). Across the different muscle strength assessment methods, handgrip strength consistently demonstrated a stronger association with postoperative complications.
Conclusion
Sarcopenia defined according to the EWGSOP criteria and with international cut-off points is associated with an increased risk of postoperative complications following pancreatic resection. Using regionally based cut-off points, the prevalence of sarcopenia is higher, but it does not confer a higher postoperative complication risk. The use of different muscle strength assessment methods results in vastly different estimates of prevalence of low strength and associations with postoperative outcomes.