Skip to main content

Advertisement

SpringerLink
Log in

The impact of sarcopenia on adverse events associated with gastric endoscopic submucosal dissection

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

A Correction to this article was published on 02 January 2024

This article has been updated

Abstract

Background

Endoscopic submucosal dissection (ESD) is one of the main methods of treatments for early gastric cancer. Sarcopenia is a known risk factor for postoperative adverse events; however, the effect of sarcopenia on gastric ESD is unclear. We investigated the impact of sarcopenia on short-term prognosis after gastric ESD.

Methods

This was a retrospective cohort study. We reviewed 832 patients who underwent gastric ESD between January 2015 and December 2019 and classified them into two groups: sarcopenia and non-sarcopenia groups. The curative resection rate, adverse events, and lengths of hospital stay were evaluated. We also evaluated risk factors associated with adverse events.

Results

700 patients were analyzed (239 in the sarcopenia group and 461 in the non-sarcopenia group). The curative resection rates were similar in both groups. Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2 (17% vs. 10%) were significantly more common, and the length of hospital stay was longer (8 vs. 7 days) in the sarcopenia group. Univariate analysis identified age ≥ 75 years, antithrombotic medication, history of gastric surgery, submucosal (SM) invasion, and sarcopenia as risk factors for CTCAE grade ≥ 2. Multivariate analysis showed that sarcopenia [odds ratio (OR) 1.79, 95% confidence interval (CI) 1.11–2.89, p = 0.016], history of gastric surgery (OR 9.32, 95% CI 1.97–44.05, p = 0.005), and SM invasion (OR 2.14, 95% CI 1.24–3.70, p = 0.006) were significant independent risk factors.

Conclusions

Sarcopenia significantly affected short-term prognosis and is a novel risk factor for gastric ESD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

References

  1. International Agency for Research. CANCER FACT SHEETS. World Health Organization. https://gco.iarc.fr/today/data/factsheets/cancers/7-Stomach-fact-sheet.pdf. Accessed 22 February 2020.

  2. Ono H, Yao K, Fujishiro M, Oda I, Uedo N, Nimura S, Yahagi N, Iishi H, Oka M, Ajioka Y, Ichinose M, Matsui T (2021) Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Dig Endosc 33(1):4–20

    Article  PubMed  Google Scholar 

  3. Sumiyama K (2017) Past and current trends in endoscopic diagnosis for early stage gastric cancer in Japan. Gastric Cancer 20(S1):20–27

    Article  PubMed  Google Scholar 

  4. Hahn KY, Park CH, Lee YK, Chung H, Park JC, Shin SK, Lee YC, Kim HI, Cheong JH, Hyung WJ, Noh SH, Lee SK (2018) Comparative study between endoscopic submucosal dissection and surgery in patients with early gastric cancer. Surg Endosc 32(1):73–86

    Article  PubMed  Google Scholar 

  5. Tae CH, Shim KN, Kim BW, Kim JH, Hong SJ, Baik GH, Song HJ, Kim YS, Jang SH, Jung HK (2020) Comparison of subjective quality of life after endoscopic submucosal resection or surgery for early gastric cancer. Sci Rep 10(1):6680

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Charlson ME, Pompei P, Ales KL, Mackenzie CT (1987) A new method of classifying prognostic in longitudinal studies: development. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  7. Akasaka T, Nishida T, Tsutsui S, Michida T, Yamada T, Ogiyama H, Kitamura S, Ichiba M, Komori M, Nishiyama O, Nakanishi F, Zushi S, Nishihara A, Iijima H, Tsujii M, Hayashi N (2011) Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by Osaka university ESD study group. Dig Endosc 23(1):73–77

    Article  PubMed  Google Scholar 

  8. Sekiguchi M, Oda I, Suzuki H, Abe S, Nonaka S, Yoshinaga S, Taniguchi H, Sekine S, Saito Y (2017) Clinical outcomes and prognostic factors in gastric cancer patients aged ≥85 years undergoing endoscopic submucosal dissection. Gastrointest Endosc 85(5):963–972

    Article  PubMed  Google Scholar 

  9. Toya Y, Endo M, Nakamura S, Akasaka R, Yanai S, Kawasaki K, Koeda K, Eizuka M, Fujita Y, Uesugi N, Ishida K, Sugai T, Matsumoto T (2019) Long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection for gastric cancer in elderly patients aged ≥ 75 years. Gastric Cancer 22(4):838–844

    Article  PubMed  Google Scholar 

  10. Iwai N, Dohi O, Naito Y, Inada Y, Fukui A, Takayama S, Ogita K, Terasaki K, Nakano T, Ueda T, Okayama T, Yoshida N, Katada K, Kamada K, Uchiyama K, Ishikawa T, Handa O, Takagi T, Konishi H, Yagi N, Itoh Y (2018) Impact of the Charlson comorbidity index and prognostic nutritional index on prognosis in patients with early gastric cancer after endoscopic submucosal dissection. Dig Endosc 30(5):616–623

    Article  PubMed  Google Scholar 

  11. Beaudart C, Reginster JY, Petermans J, Gillain S, Quabron A, Locquet M, Slomian J, Buckinx F, Bruyère O (2015) Quality of life and physical components linked to sarcopenia: the SarcoPhAge study. Exp Gerontol 69:103–110

    Article  CAS  PubMed  Google Scholar 

  12. Woo J, Leung J, Morley JE (2015) Defining sarcopenia in terms of incident adverse outcomes. J Am Med Dir Assoc 16(3):247–252

    Article  PubMed  Google Scholar 

  13. Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG (2014) Sarcopenic obesity and risk of cardiovascular disease and mortality: a population-based cohort study of older men. J Am Geriatr Soc 62(2):253–260

    Article  PubMed  Google Scholar 

  14. Cerri AP, Bellelli G, Mazzone A, Pittella F, Landi F, Zambon A, Annoni G (2015) Sarcopenia and malnutrition in acutely ill hospitalized elderly: prevalence and outcomes. Clin Nutr 34(4):745–751

    Article  PubMed  Google Scholar 

  15. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H (2020) Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc 21(3):300-307.e2

    Article  PubMed  Google Scholar 

  16. Kamarajah SK, Bundred J, Tan BHL (2019) Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis. Gastric Cancer 22(1):10–22

    Article  PubMed  Google Scholar 

  17. Lee JS, Kim YS, Kim EY, Jin W (2018) Prognostic significance of CT-determined sarcopenia in patients with advanced gastric cancer. PLoS ONE 13(8):1–11

    Article  Google Scholar 

  18. Shachar SS, Williams GR, Muss HB, Nishijima TF (2016) Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer 57:58–67

    Article  PubMed  Google Scholar 

  19. Kato M, Michida T, Kusakabe A, Sakai A, Hibino C, Kato M, Tokuda Y, Kawai T, Hamano M, Chiba M, Maeda K, Yamamoto K, Naito M, Ito T (2016) Safety and short-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients. Endosc Int Open 4(5):E521–E526

    Article  PubMed  PubMed Central  Google Scholar 

  20. Association JGC (ed) (2017) Japanese Classification of Gastric Carcinoma, 15th edn. Kanehara Shuppan, Tokyo

    Google Scholar 

  21. Onodera T, Goseki N, Kosaki G (1986) Postoperative nutritional assessment in gastric and colorectal cancer. Nihon Geka Gakkai Zasshi 87(8):853–858

    PubMed  Google Scholar 

  22. Bouillanne O, Morineau G, Dupant C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C (2005) Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82(4):777–783

    Article  CAS  PubMed  Google Scholar 

  23. Japanese gastric cancer treatment guidelines 2018 (5th edition) (2021) Gastric Cancer 24(1):1–21

  24. Mitsiopoulos N, Baumgartner RN, Heymsfield SB, Lyons W, Gallagher D, Ross R (1998) Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol 85(1):115–122

    Article  CAS  PubMed  Google Scholar 

  25. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE (2012) Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 107(6):931–936

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Zhuang CL, Huang DD, Pang WY, Zhou CJ, Wang SL, Lou N, Ma LL, Yu Z, Shen X (2016) Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: analysis from a large-scale cohort. Med (United States) 95(13):e3164

    Google Scholar 

  27. Goto S, Arimoto J, Higurashi T, Takahashi K, Ohkubo N, Kawamura N, Tamura T, Tomonari H, Iwasaki A, Taniguchi L, Chiba H, Atsukawa K, Saigusa Y, Nakajima A (2020) Efficacy and safety of colorectal endoscopic submucosal dissection in patients with sarcopenia. Surg Endosc. https://doi.org/10.1007/s00464-020-08041-1

    Article  PubMed  PubMed Central  Google Scholar 

  28. Prado CM, Purcell SA, Alish C, Pereira SL, Deutz NE, Heyland DK, Goodpaster BH, Tappenden KA, Heymsfield SB (2018) Implications of low muscle mass across the continuum of care: a narrative review. Ann Med 50(8):675–693

    Article  PubMed  Google Scholar 

  29. Shen W, Punyanitya M, Wang ZM, Gallagher D, St-Onge MP, Albu J, Heymsfield SB, Heshka S (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol 97(6):2333–2338

    Article  PubMed  Google Scholar 

  30. Epidemiologic and methodologic problems in determining nutritional status of older persons. Proceedings of a conference. Albuquerque, New Mexico, October 19–21, 1988. Am J Clin Nutr. 1989;50(5 Suppl):1121–1235

  31. Ministry of Health, Labour and Welfare. https://www.mhlw.go.jp/english/database/db-hw/lifetb19/dl/lifetb19-01.pdf. Accessed 22 Feb 2020

  32. Hori M, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H (2015) Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol 45(9):884–891

    Article  PubMed  Google Scholar 

  33. Nishide N, Ono H, Kakushima N, Takizawa K, Tanaka M, Matsubayashi H, Yamaguchi Y (2012) Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in remnant stomach or gastric tube. Endoscopy 44(6):577–583

    Article  CAS  PubMed  Google Scholar 

  34. Choi CW, Kang DH, Kim HW, Hong JB, Park SB, Kim SJ, Cho M (2015) High dose proton pump inhibitor infusion versus bolus injection for the prevention of bleeding after endoscopic submucosal dissection: prospective randomized controlled study. Dig Dis Sci 60(7):2088–2096

    Article  CAS  PubMed  Google Scholar 

  35. Yamamoto K, Nagatsuma Y, Fukuda Y, Hirao M, Nishikawa K, Miyamoto A, Ikeda M, Nakamori S, Sekimoto M, Fujitani K, Tsujinaka T (2017) Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer. Gastric Cancer 20(5):913–918

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Hiroyuki Hisada and Naoki Tamura have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Hiroyuki Hisada, Naoki Tamura, Yosuke Tsuji, Yuko Miura, Hiroya Mizutani, Yu Takahashi, Yoshiki Sakaguchi & Mitsuhiro Fujishiro

  2. Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Sayaka Nagao & Daisuke Ohki

  3. Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kazushi Fukagawa & Nobutake Yamamichi

  4. Center for International Preventive Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Seiichi Yakabi

  5. Infection Control and Prevention Service, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Chihiro Minatsuki

  6. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Tokyo, 113-8655, Japan

    Yosuke Tsuji

Authors
  1. Hiroyuki Hisada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoki Tamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yosuke Tsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sayaka Nagao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazushi Fukagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuko Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroya Mizutani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daisuke Ohki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Seiichi Yakabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chihiro Minatsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yu Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yoshiki Sakaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Nobutake Yamamichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Mitsuhiro Fujishiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HH: Conception and design; patient enrollment and clinical treatment; data submission; analysis and interpretation of the data; drafting of the article. NT: Conception and design; patient enrollment and clinical treatment; data submission; analysis and interpretation of the data; drafting of the article. YT: Conception and design; patient enrollment and clinical treatment; data submission; analysis and interpretation of the data; critical revision of the article for important intellectual content. SN: Patient enrollment and clinical treatment; data submission. KF: Patient enrollment and clinical treatment; data submission. YM: Patient enrollment and clinical treatment; data submission. HM: Patient enrollment and clinical treatment; data submission. DO: Patient enrollment and clinical treatment; data submission. SY: Patient enrollment and clinical treatment; data submission. CM: Patient enrollment and clinical treatment; data submission. YT: Patient enrollment and clinical treatment; data submission. YS: Patient enrollment and clinical treatment; data submission. NY: Patient enrollment and clinical treatment; data submission. MF: Final approval of the article.

Corresponding author

Correspondence to Yosuke Tsuji.

Ethics declarations

Disclosures

Hiroyuki Hisada MD, Naoki Tamura MD, PhD, Yosuke Tsuji MD, PhD, Sayaka Nagao MD, PhD, Kazushi Fukagawa MD, PhD, Yuko Miura MD, PhD, Hiroya Mizutani MD, PhD, Daisuke Ohki MD, PhD, Seiichi Yakabi MD, PhD, Chihiro Minatsuki MD, PhD, Yu Takahashi MD, PhD, Yoshiki Sakaguchi MD, PhD, Nobutake Yamamichi MD, PhD, and Mitsuhiro Fujishiro MD, PhD have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hisada, H., Tamura, N., Tsuji, Y. et al. The impact of sarcopenia on adverse events associated with gastric endoscopic submucosal dissection. Surg Endosc 36, 6387–6395 (2022). https://doi.org/10.1007/s00464-021-08965-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08965-2

Keywords

Search

Navigation