Relationship Between Fat Mass Indices and Postoperative Complications After Laparoscopic Gastrectomy in Patients With Gastric Cancer: A Propensity Score Matching Analysis

Abstract

Background/Aim: Visceral adipose tissue index (VAI) and visceral-to-subcutaneous adipose tissue area ratio (VSR) are indices related to visceral fat mass, and intramuscular adipose tissue content (IMAC) is an index related to intramuscular fat. We investigated the impact of fat mass-related indices on the incidence of postoperative complications. Patients and Methods: Patients who underwent radical laparoscopic gastrectomy for c-stage I primary gastric cancer between April 2014 and December 2020 were included. We investigated the relationship between both VAI, VSR, IMAC and postoperative complications. For each value, the median was used as a cut-off point, the patients were divided into high- and low-fat groups, and background adjustments using propensity score matching analysis were used to compare these two groups. Results: Of the 490 patients, 245 (50.0%) were in the high-VAI group, 243 (49.6%) in the high-VSR group, and 239 (48.8%) in the high-IMAC group. After matching, intra-abdominal abscess and pancreatic fistula were greater in the high-VAI group than those in the low-VAI group (p=0.081 and p=0.081, respectively), and were also significantly greater in the high-VSR group (p=0.012 and p=0.025, respectively). However, anastomotic leakage was greater in the high-IMAC group than in the low-IMAC group (p=0.050). Conclusion: VAI and VSR, which reflect visceral fat mass, were useful in predicting intra-abdominal infections, whereas IMAC, which reflects intramuscular fat, was useful in predicting anastomotic leakage. Preoperative prediction using a combination of these factors may aid clinical assessment of complication risk.