Sarcopenia in pancreatic surgery. Systematic review

Background: Attention has increased about sarcopenia as an important predictor of postoperative outcomes following major surgery. On the one hand, the study of muscle mass in patients undergoing pancreatic surgery could be an effective way to stratify surgical risks. On the other hand, patients with pancreatic diseases have a high risk for sarcopenia due to their underlying pathologies. Material & Methods: We perform a systematic review of the literature, according PRISMA guidelines, to search articles about sarcopenia and pancreatic surgery. Results: Sixteen articles comparing patients undergoing pancreatic surgery with and without sarcopenia were included. All of them were case series, including 5071 patients. Sarcopenia diagnosis criteria and cut off values in all these series are diverse. 1408 of them (27.76%) were classified like sarcopenic patients. Twelve studies were carried out exclusively in oncological patients, eleven of them only include oncological patients undergoing pancreatic surgery and the other one published by Buettner et al also study sarcopenia influence in hepatic cancer and CRC patients. Only 3 studies include patients with benign pathology undergoing pancreas resection in addition to oncological patients. Benign pathologies represent a 2.15% of the studied population (98/4562). And the last one, Fukuda et al report the only study about sarcopenia influence in pancreatic transplantation. Table 1 shows the impact of sarcopenia on postoperative outcomes and mortality. Only 3 studies find a higher risk of pancreatic fistula in patients with sarcopenia. Sandini et al reports a higher trend of abdominal abscesses in sarcopenic patients. No difference where observed according to other morbidities. Conclusion: The impact of sarcopenia on morbidity and perioperative mortality in pancreatic resections is still unclear. It is necessary to unify criteria both in the definition and in the cut off values. Prospective studies and consensus on sarcopenia diagnosis should be achieve.