Preoperative low skeletal muscle mass index assessed using L3-CT as a prognostic marker of clinical outcomes in pancreatic cancer patients undergoing surgery: a systematic review and meta-analysis.

BACKGROUND

Reduction in muscle mass can be routinely quantified using computed tomography (CT) of the third lumbar vertebra (L3) during a curative pancreatic cancer (PC) course. This systematic review and meta-analysis aimed to assess the association between preoperative low skeletal muscle index (SMI) measured by L3-CT and postoperative clinical outcomes in PC resectable patients.

METHODS

Three electronic databases (PubMed, Web of Science, and Scopus) were searched for articles published through May 2023. Duplicate titles and abstracts, full-text screening, and data extraction were performed. A meta-analysis was performed for overall survival (OS), recurrence-free survival (RFS), postoperative pancreatic fistula (POPF), morbidity, and postoperative length of stay (P-LOS). The risk of bias was assessed.

RESULTS

A total of 2942 patients with PC from 11 studies were identified. Preoperative low SMI was found in 50.9% of PC resectable patients. Preoperative low SMI was significantly associated with adjusted OS (adjusted hazard ratio, 1.52; 95% CI 1.25-1.86, P < 0.0001). No significant associations were found between preoperative low SMI and RFS, number of POPF, significant morbidity, and P-LOS ( P >0.05).

CONCLUSIONS

SMI should be evaluated in a timely manner as a predictor of OS in PC resectable patients. Studies assessing nutritional protocols for maintaining/increasing skeletal muscle mass are required to develop a personalized nutritional approach to improve clinical outcomes.