[in Japanese]

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Sarcopenia is defined as the attenuation of muscle mass and strength that is associated with aging. Sarcopenia is one of the causes of frailty; it is associated with impaired activity of daily life, fracture and poor treatment outcome of various cancers. The aim of this study was to examine the prevalence of sarcopenia among elderly gastric cancer patients and the impact on postoperative complications. Of 69 elderly ( ≥ 65 years old) gastric cancer patients undergoing gastrectomy between July 2012 and February 2014 in our institute, 38 patients (55.1%) were diagnosed with sarcopenia, based on the criteria proposed by European Working Group on Sarcopenia in Older People (EWGSOP). Sarcopenic patients were significantly older (77 vs. 73 years old, p=0.025) and had a lower Body Mass Index (BMI) (20.4 vs. 23.5 kg/m2, p=0.0016), compared to non-sarcopenic patients. In terms of preoperative nutritional intake assessed by a national registered dietitian in our institute using Food Frequency Questionnaire (FFQ), calories and protein of food intake in sarcopenic patients were significantly smaller than that in non-sarcopenic patients [25.6 vs. 29.9 kcal/(IBW)kg, p=0.0060 and 0.95 vs. 1.12 g/(IBW)kg, p=0.0041, respectively]. The incidence of severe postoperative complications greater than Grade Ⅲ a, according to the Clavien-Dindo classification was greater in sarcopenic patients (23.7 vs. 6.5%, p=0.043) and sarcopenia was identified as an independent risk factor of severe complications after gastrectomy from Logistic multivariate regression analysis (odds ratio 5.86, 95% confidence interval 1.06.51.65, p=0.042). Optimal nutritional support has a possible role to improve the short-term treatment outcome after gastrectomy for elderly gastric cancer patients.

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Zinc is one of the essential trace elements. However, there are few reports on the changes of serum zinc levels in the perioperative period. We retrospectively analyzed perioperative serum zinc levels in 319 patients undergoing gastrointestinal surgery [gastrectomy in 178 patients, colectomy in 73 patients, pancreaticoduodenectomy (PD) in 53 patients and hepatectomy in 15 patients]. Furthermore, we analyzed the amount of zinc in urine, pancreatic juice and bile in patients undergoing PD. In the 178 patients undergoing gastrectomy, we studied the correlations between preoperative serum zinc levels and postoperative complications. The average preoperative serum zinc levels were 75.5±12.1 μg/dl; zinc levels were less than 65 μg/dl in 56 patients (17.6%). There was a positive correlation between preoperative serum zinc levels and serum albumin levels (R=0.56). Serum zinc levels were markedly decreased on the first postoperative day and recovered to preoperative levels in 7 to 14 postoperative days. Serum zinc levels of patients undergoing PD and hepatectomy decreased more than those of patients undergoing gastrectomy and colectomy. Patients undergoing gastrectomy whose serum zinc levels were under 65 μg/dl were more likely to develop postoperative complications (P=0.10). Zinc was excreted primarily into urine and pancreatic juice, with only a slight excretion in bile. Serum zinc levels in the perioperative period were markedly changed, therefore it may be necessary to conduct perioperative management, including zinc complement .

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