Pre-operative Sarcopenia Predicts Low Islet Cell Yield Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis.
Chronic pancreatitis
Sarcopenia
TPIAT
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
08
10
2019
accepted:
04
06
2020
pubmed:
20
6
2020
medline:
15
4
2021
entrez:
20
6
2020
Statut:
ppublish
Résumé
Sarcopenia defined as degenerative loss of skeletal muscle mass associated with aging, represents an objective parameter to measure frailty and to estimate patient's physiologic reserves. It is a robust predictor of post-operative complications in transplantation and major oncologic surgeries. There is no data regarding the prevalence of sarcopenia in chronic pancreatitis or its impact on the outcome of patients undergoing TPIAT for CP. We sought to estimate the prevalence of sarcopenia, its impact on post-operative morbidity and prediction of islet yield and metabolic outcomes in patients undergoing TPIAT. Adult patients undergoing TPIAT between 2008 and 2018 were identified from our prospectively maintained database and were included if they had CT within 6 months before TPIAT. Skeletal muscle index (SMI) was evaluated by pre-operative CT at the level of L3 vertebra. Sarcopenia was defined as SMI < 52.4 in males and < 38.5 in females. Post-operative morbidity occurring within 90 days after TPIAT was graded as per the validated Clavien-Dindo score. Major post-surgical morbidity was defined as Clavien-Dindo score of IIIa or more. The yield of islets was quantified as islet equivalents (IEQ) and IEQ/kg recipient body weight was calculated. One hundred and thirty-eight patients underwent TPIAT, with 46 (one-third) being classified as having pre-operative sarcopenia based on CT. No significant differences were observed in the incidence of any major surgical complications, length of hospital stay (median (range in days) 11 Sarcopenia is frequent in CP patients undergoing TPIAT, but not readily recognized by standard anthropometric measurement. Sarcopenia was associated with increased chance of discharge to a residential rehabilitation facility and with a poor islet yield during TPIAT. It is therefore critical to optimize nutrition prior to TPIAT surgery in CP patients.
Sections du résumé
BACKGROUND AND AIM
Sarcopenia defined as degenerative loss of skeletal muscle mass associated with aging, represents an objective parameter to measure frailty and to estimate patient's physiologic reserves. It is a robust predictor of post-operative complications in transplantation and major oncologic surgeries. There is no data regarding the prevalence of sarcopenia in chronic pancreatitis or its impact on the outcome of patients undergoing TPIAT for CP. We sought to estimate the prevalence of sarcopenia, its impact on post-operative morbidity and prediction of islet yield and metabolic outcomes in patients undergoing TPIAT.
METHODS
Adult patients undergoing TPIAT between 2008 and 2018 were identified from our prospectively maintained database and were included if they had CT within 6 months before TPIAT. Skeletal muscle index (SMI) was evaluated by pre-operative CT at the level of L3 vertebra. Sarcopenia was defined as SMI < 52.4 in males and < 38.5 in females. Post-operative morbidity occurring within 90 days after TPIAT was graded as per the validated Clavien-Dindo score. Major post-surgical morbidity was defined as Clavien-Dindo score of IIIa or more. The yield of islets was quantified as islet equivalents (IEQ) and IEQ/kg recipient body weight was calculated.
RESULTS
One hundred and thirty-eight patients underwent TPIAT, with 46 (one-third) being classified as having pre-operative sarcopenia based on CT. No significant differences were observed in the incidence of any major surgical complications, length of hospital stay (median (range in days) 11
CONCLUSION
Sarcopenia is frequent in CP patients undergoing TPIAT, but not readily recognized by standard anthropometric measurement. Sarcopenia was associated with increased chance of discharge to a residential rehabilitation facility and with a poor islet yield during TPIAT. It is therefore critical to optimize nutrition prior to TPIAT surgery in CP patients.
Identifiants
pubmed: 32557018
doi: 10.1007/s11605-020-04687-3
pii: 10.1007/s11605-020-04687-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2423-2430Références
Duggan SN. Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis. Proc Nutr Soc 2017;1–11.
Uc A, Andersen DK, Bellin MD, et al. Chronic Pancreatitis in the 21st Century - Research Challenges and Opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas 2016;45:1365–1375.
doi: 10.1097/MPA.0000000000000713
Duggan SN, Ní Chonchubhair HM, Lawal O, et al. Chronic pancreatitis: A diagnostic dilemma. World J Gastroenterol 2016;22:2304–2313.
doi: 10.3748/wjg.v22.i7.2304
Gianotti L, Besselink MG, Sandini M, et al. Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2018;164:1035–1048.
doi: 10.1016/j.surg.2018.05.040
Prado CMM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9:629–635.
doi: 10.1016/S1470-2045(08)70153-0
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48:16–31.
doi: 10.1093/ageing/afy169
Shen W, Punyanitya M, Wang Z, et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J. Appl. Physiol. 2004;97:2333–2338.
doi: 10.1152/japplphysiol.00744.2004
Pecorelli N, Capretti G, Sandini M, et al. Impact of Sarcopenic Obesity on Failure to Rescue from Major Complications Following Pancreaticoduodenectomy for Cancer: Results from a Multicenter Study. Ann Surg Oncol 2018;25:308–317.
doi: 10.1245/s10434-017-6216-5
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004;240:205–213.
doi: 10.1097/01.sla.0000133083.54934.ae
Whitcomb DC, Frulloni L, Garg P, et al. Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition. Pancreatology 2016;16:218–224.
doi: 10.1016/j.pan.2016.02.001
Duggan SN, Purcell C, Kilbane M, et al. An association between abnormal bone turnover, systemic inflammation, and osteoporosis in patients with chronic pancreatitis: a case-matched study. Am. J. Gastroenterol. 2015;110:336–345.
doi: 10.1038/ajg.2014.430
Bellin MD, Freeman ML, Gelrud A, et al. Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology 2014;14:27–35.
doi: 10.1016/j.pan.2013.10.009
Sutherland DER, Radosevich DM, Bellin MD, et al. Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis. J. Am. Coll. Surg. 2012;214:409–424 discussion 424-426.
doi: 10.1016/j.jamcollsurg.2011.12.040
Chinnakotla S, Bellin M, Schwarzenberg S, et al. Total Pancreatectomy and Islet Autotransplantation in Children for Chronic Pancreatitis. Annals of Surgery 2014;260:56–64.
doi: 10.1097/SLA.0000000000000569
Chinnakotla S, Beilman GJ, Dunn TB, et al. Factors Predicting Outcomes After a Total Pancreatectomy and Islet Autotransplantation Lessons Learned From Over 500 Cases. Ann. Surg. 2015;262:610–622.
doi: 10.1097/SLA.0000000000001453
Bellin MD, Gelrud A, Arreaza-rubin G, et al. Total Pancreatectomy With Islet Autotransplantation: Summary of an Niddk Workshop. Annals of Surgery 2015;261:21–29.
doi: 10.1097/SLA.0000000000001059
Muscaritoli M, Anker SD, Argilés J, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics.” Clin Nutr 2010;29:154–159.
doi: 10.1016/j.clnu.2009.12.004
DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann. Surg. 2006;244:931–937; discussion 937-939.
doi: 10.1097/01.sla.0000246856.03918.9a
Bellin MD, Beilman GJ, Sutherland DE, et al. How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis? J. Am. Coll. Surg. 2019;228:329–339.
doi: 10.1016/j.jamcollsurg.2018.12.019
Shahbazov R, Pattarabanjird T, Zaydfudim V, et al. Impact of Sarcopenia on Total Pancreatectomy and Auto Islet Transplantation in Chronic Pancreatitis Patients [Internet]. World Congress of the International Pancreas & Islet Transplant AssociationLyon, Catholic University: Available from: http://www.ipita2019.org/programme-scientifique
OConnor D, Kok T, Purcell C, et al. Investigating the prevalence of sarcopenia in chronic pancreatitis in an irish cohort: A CT-scan based pilot study. Pancreatology 2014;3 Supplement 1:S74.
doi: 10.1016/j.pan.2014.05.628
Shintakuya R, Uemura K, Murakami Y, et al. Sarcopenia is closely associated with pancreatic exocrine insufficiency in patients with pancreatic disease. Pancreatology 2017;17:70–75.
doi: 10.1016/j.pan.2016.10.005
Olesen SS, Büyükuslu A, Køhler M, et al. Sarcopenia associates with increased hospitalization rates and reduced survival in patients with chronic pancreatitis. Pancreatology 2019;19:245–251.
doi: 10.1016/j.pan.2019.01.006
Ratnayake CB, Loveday BP, Shrikhande SV, et al. Impact of preoperative sarcopenia on postoperative outcomes following pancreatic resection: A systematic review and meta-analysis. Pancreatology 2018;18:996–1004.
doi: 10.1016/j.pan.2018.09.011
Mesinovic J, Zengin A, De Courten B, et al. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes 2019;12:1057–1072.
doi: 10.2147/DMSO.S186600
Bellin MD, Whitcomb DC, Abberbock J, et al. Patient and Disease Characteristics Associated With the Presence of Diabetes Mellitus in Adults With Chronic Pancreatitis in the United States. Am. J. Gastroenterol. 2017;112:1457–1465.
doi: 10.1038/ajg.2017.181
Domschke S, Stock KP, Pichl J, et al. Beta-cell reserve capacity in chronic pancreatitis. Hepatogastroenterology 1985;32:27–30.
pubmed: 3886512
Nyboe Andersen B, Krarup T, Thorsgaard Pedersen NT, et al. B cell function in patients with chronic pancreatitis and its relation to exocrine pancreatic function. Diabetologia 1982;23:86–89.
doi: 10.1007/BF01271165
Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet 2019;393:2636–2646.
doi: 10.1016/S0140-6736(19)31138-9