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World J Gastrointest Oncol. Jul 15, 2019; 11(7): 527-537
Published online Jul 15, 2019. doi: 10.4251/wjgo.v11.i7.527
Sarcopenia in pancreatic cancer – effects on surgical outcomes and chemotherapy
Miu Yee Chan, Kenneth Siu Ho Chok
Miu Yee Chan, Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
Kenneth Siu Ho Chok, Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
Author contributions: Chan MY performed the literature review and drafted the manuscript; Chok KSH was responsible for the concept and supervision of the study and final approval of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kenneth Siu Ho Chok, FRCS (Ed), Associate Professor, Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. Chok6275@hku.hk
Telephone: +852-22553025
Received: January 26, 2019
Peer-review started: January 28, 2019
First decision: April 15, 2019
Revised: April 23, 2019
Accepted: May 21, 2019
Article in press: May 22, 2019
Published online: July 15, 2019
Abstract

Sarcopenia is found in up to 65% of pancreatic cancer patients. The definition and diagnostic methods for sarcopenia have changed over the years, and the measurement of skeletal muscle mass with cross-sectional imaging has become the most popular way of assessment, although the parameters measured vary among different studies. It is still debatable that there is an association between sarcopenia and postoperative pancreatic fistula, but most studies showed a higher risk in patients with sarcopenic obesity. Long-term survival is worse in sarcopenic patients, as shown by meta-analysis. Sarcopenia is also associated with decreased survival and higher toxicity in patients receiving chemotherapy, and chemotherapy also tends to potentiate sarcopenia. Treatment for sarcopenia still remains an area for research, although oral supplements, nutritional modifications and exercise training have been shown to improve sarcopenia.

Keywords: Sarcopenia, Pancreatic cancer, Clinical outcomes, Surgical outcomes, Chemotherapy, Radiotherapy

Core tip: Sarcopenia is a common condition found in pancreatic cancer patients. There is growing evidence showing that sarcopenia is associated with worse survival outcomes. This article summarizes the current evidence for the definition and diagnosis of sarcopenia, as well as its relationship with surgical outcomes, survival and chemotherapy.