SSAT - PROGNOSTIC SIGNIFICANCE OF BODY COMPOSITION DETERMINED BY BIOELECTRICAL IMPEDANCE ANALYSIS (BIA) IN UPPER GASTROINTESTINAL CANCER SURGERY

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PROGNOSTIC SIGNIFICANCE OF BODY COMPOSITION DETERMINED BY BIOELECTRICAL IMPEDANCE ANALYSIS (BIA) IN UPPER GASTROINTESTINAL CANCER SURGERY
Paul Blake, Neil Patel^*, Chris Brown, Guy Blackshaw, Arfon G. Powell, Jeniffer Wheat, Andi Beamish, Wyn G. Lewis
General Surgery, University Hospital Wales, Cardiff, Wales, United Kingdom

Malnutrition and sarcopenia are associated with higher rates of operative morbidity and therefore represent potentially reversible prognostic risk factors. Bioelectrical Impedance Analysis (BIA) is a non-invasive, easily reproducible and simple means of accurately measuring body composition, and the aim of this study was to determine the prognostic value of BIA and sarcopenia in UGI cancer surgery.

Consecutive 125 patients [median age 66 years (24-86), 94 males, 73 oesophageal and 52 gastric cancers] underwent pre-operative BIA (Maltron Bioscan 920) assessment to measure percentage Free Fat Mass (FFM%), percentage Body Fat (BF%), percentage Lean Muscle Mass (LMM%), Total Body Water (TBW%), Intracellular and Extracellular Water Volume (ICV, ECV, %), and Phase Angle (PhA). Furthermore, the lean muscle mass for each patient was divided by their total body weight, the results were then split into quartiles and the quartile with the lowest lean muscle mass to total body weight ratio was used as a surrogate for sarcopenia. Primary outcome measures were operative morbidity and survival.

Pre-operatively anaerobic threshold (AT) correlated with ICV% (R=0.370, p=0.001), LMM% (R=0.236, p=0.042), and PhA (R=0.289, p=0.010). Surgery mortality risk (O-POSSUM score) correlated with FFM% (R=-0.247, p=0.020) and BF% (R=0.259, p=0.015). Sarcopenia was associated with AT (R=0.277, p=0.017), operative severity (R=-0.330, p=0.003), P-POSSUM morbidity (R=-0.306, p=0.005), and P-POSSUM mortality (R=-0.239, p=0.031). Sarcopenia was also associated with female gender (R=-0.705, p<0.001), and tumours located in the distal oesophagus (R=-319, p=0.033). Open and close laparotomy was associated with FFM% (R=0.200, p=0.027), and BF% (R=-0.197, p=0.030). Post-operative morbidity (Clavien-Dindo ≥3) was associated with ICV (R=0.265, p=0.018), TBW (R=0.269, p=0.019), and sarcopenia (R=0.232, p=0.045). Critical care length of stay was associated with ICV (R=0.279, p=0.009), LMM (R=0.302, p=0.006), PhA (R=0.239, p=0.025) and sarcopenia (R=-0.236, p=0.011). On univariate analysis survival was associated with PhA (p<0.0001), FFM% (p<0.0001), BF% (p<0.0001), TBW% (p<0.0001), ECV% (p<0.0001), and sarcopenia (p<0.0001). On multivariate analysis sarcopenia (HR 1.072, 95% CI 1.018-1.130, p=0.009) and ICV% (HR 0.851, 95% CI 0.733-0.988, p=0.034) were independently and significantly associated with survival.

In conclusion BIA defined body composition is an important and independent prognostic indicator in UGI cancer. Further research is warranted to determine critical body composition values so that enhanced recovery programmes containing bespoke nutritional strategies may be developed to improve outcomes and survival.

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