Skeletal muscle loss after laparoscopic gastrectomy assessed by measuring the total psoas area



Skeletal muscle loss after gastrectomy can worsen patients’ quality of life and prognosis. Laparoscopic gastrectomy is less invasive than open gastrectomy and has become commonly performed. However, the degree of skeletal muscle loss after laparoscopic procedures remains unclear. We herein report the degree and risk factors of psoas muscle loss after laparoscopic gastrectomy for gastric cancer.


The total psoas area (TPA) on computed tomography of 50 consecutive patients who underwent laparoscopic total gastrectomy (LTG) and 167 consecutive patients who underwent laparoscopic distal gastrectomy (LDG) for gastric cancer was retrospectively evaluated at one postoperative year. The TPA loss was compared between LDG and LTG and univariate and multivariate analyses were performed to identify the risk factors for TPA loss > 10%.


The median TPA decrease rate was 5.9% in the LDG group and 15.6% in the LTG group. LTG and postoperative respiratory complications were independent factors associated with a severe TPA loss of > 10%. In the LTG group, no independent factors were identified in a multivariate analysis. In the LDG group, postoperative complications were identified as an independent risk factor for TPA loss > 10%.


Laparoscopic gastrectomy leads to postoperative TPA loss, especially in patients who underwent LTG and had postoperative respiratory complications. Postoperative complications after LDG were also a risk factor for TPA loss.

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  1. 1.

    Aoyama T, Sato T, Maezawa Y, Kano K, Hayashi T, Yamada T, et al. Postoperative weight loss leads to poor survival through poor S-1 efficacy in patients with stage II/III gastric cancer. Int J Clin Oncol. 2017;22:476–83.

    Article  Google Scholar 

  2. 2.

    Climent M, Munarriz M, Blazeby JM, Dorcaratto D, Ramon JM, Carrera MJ, et al. Weight loss and quality of life in patients surviving 2 years after gastric cancer resection. Eur J Surg Oncol. 2017;43:1337–433.

    CAS  Article  Google Scholar 

  3. 3.

    Huang DD, Ji YB, Zhou DL, Li B, Wang SL, Chen XL, et al. Effect of surgery-induced acute muscle wasting on postoperative outcomes and quality of life. J Surg Res. 2017;218:58–66.

    Article  Google Scholar 

  4. 4.

    Yamaoka Y, Fujitani K, Tsujinaka T, Yamamoto K, Hirao M, Sekimoto M. Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy. Gastric Cancer. 2015;18:382–9.

    CAS  Article  Google Scholar 

  5. 5.

    Kugimiya N, Harada E, Oka K, Kawamura D, Suehiro Y, Takemoto Y, et al. Loss of skeletal muscle mass after curative gastrectomy is a poor prognostic factor. Oncol Lett. 2018;16:1341–7.

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Park HS, Kim HS, Beom SH, Rha SY, Chung HC, Kim JH, et al. Marked loss of muscle, visceral fat, or subcutaneous fat after gastrectomy predicts poor survival in advanced gastric cancer: single-center study from the CLASSIC trial. Ann Surg Oncol. 2018;25:3222–300.

    Article  Google Scholar 

  7. 7.

    Davis JL, Selby LV, Chou JF, Schattner M, Ilson DH, Capanu M, et al. Patterns and predictors of weight loss after gastrectomy for cancer. Ann Surg Oncol. 2016;23:1639–45.

    Article  Google Scholar 

  8. 8.

    Sugiyama M, Oki E, Ando K, Nakashima Y, Saeki H, Maehara Y. Laparoscopic proximal gastrectomy maintains body weight and skeletal muscle better than total gastrectomy. World J Surg. 2018;42:3270–6.

    Article  Google Scholar 

  9. 9.

    Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, et al. Postoperative changes in body composition after gastrectomy. J Gastrointest Surg. 2005;9:313–9.

    Article  Google Scholar 

  10. 10.

    Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Watanabe M, et al. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc. 2013;27:1695–705.

    Article  Google Scholar 

  11. 11.

    Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017;20:699–708.

    Article  Google Scholar 

  12. 12.

    Tsuchiya N, Kunisaki C, Makino H, Kimura J, Takagawa R, Sato S, et al. Feasibility of laparoscopy-assisted gastrectomy for gastric cancer in elderly patients: a case-control study. Surg Laparosc Endosc Percutan Tech. 2018;28:102–7.

    PubMed  Google Scholar 

  13. 13.

    Zhou CJ, Zhang FM, Zhang FY, Yu Z, Chen XL, Shen X, et al. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy. J Surg Res. 2017;211:137–46.

    Article  Google Scholar 

  14. 14.

    Jones KI, Doleman B, Scott S, Lund JN, Willians JP. Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications. Colorectal Dis. 2014;17:20–6.

    Article  Google Scholar 

  15. 15.

    Sakurai K, Kubo N, Tamura T, Toyokawa T, Amano R, Tanaka H, et al. Adverse effects of low preoperative skeletal muscle mass in patients undergoing gastrectomy for gastric cancer. Ann Surg Oncol. 2017;24:2712–9.

    Article  Google Scholar 

  16. 16.

    Yaguchi Y, Kumata Y, Horikawa M, Kiyokawa T, Iinuma H, Inaba T, et al. Clinical significance of area of psoas major muscle on computed tomography after gastrectomy in gastric cancer patients. Ann Nutr Metab. 2017;71:145–9.

    CAS  Article  Google Scholar 

  17. 17.

    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  18. 18.

    Takiguchi S, Takata A, Murakami K, Miyazaki Y, Yanagimoto Y, Kurokawa Y, et al. Clinical application of ghrelin administration for gastric cancer patients undergoing gastrectomy. Gastric Cancer. 2014;17:200–5.

    CAS  Article  Google Scholar 

  19. 19.

    Draganidis D, Karagounis LG, Athanailidis I, Chatzinikolaou A, Jamurtas AZ, Fatouros IG. Inflammaging and skeletal muscle: can protein intake make a difference? J Nutr. 2016;146:1940–52.

    CAS  Article  Google Scholar 

  20. 20.

    Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310:1591–600.

    CAS  Article  Google Scholar 

  21. 21.

    Park KB, Kwon OK, Yu W. Midterm body composition changes after open distal gastrectomy for early gastric cancer. Ann Surg Treat Res. 2018;95:192–200.

    Article  Google Scholar 

  22. 22.

    Caparelli ML, Shikhman A, Jalal A, Oppelt S, Ogg C, Allamaneni S. Prevention of postoperative pneumonia in noncardiac surgical patients: a prospective study using the National Surgical Quality Improvement Program Database. Am Surg. 2019;85(1):8–14.

    PubMed  Google Scholar 

  23. 23.

    Wang S, Xu L, Wang Q, Li J, Bai B, Li Z, et al. Postoperative complications and prognosis after radical gastrectomy for gastric cancer: a systematic review and meta-analysis of observational studies. World J Surg Oncol. 2019. March, 2019).

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20:1575–83.

    Article  Google Scholar 

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Correspondence to Yuta Yamazaki.

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The protocol for this research project was approved by the ethics committee of the institution (No. 180274).

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Yamazaki, Y., Kanaji, S., Takiguchi, G. et al. Skeletal muscle loss after laparoscopic gastrectomy assessed by measuring the total psoas area. Surg Today 50, 693–702 (2020).

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  • Laparoscopic gastrectomy
  • Gastric cancer
  • Skeletal muscle loss
  • Psoas muscle area
  • Postoperative complication