Clinical Impact of Preoperative Computed Tomography-Derived Muscle Mass, Strength, and Function in Patients Undergoing Pancreatoduodenectomy: A Prospective follow-up study.

BACKGROUND AND AIMS: Malnutrition and sarcopenia are common in gastrointestinal malignancies. However, the prognostic value of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition relative to objective muscle measures in surgical populations remains unclear. To determine the prevalence of sarcopenia and GLIM-defined malnutrition and to evaluate their associations with length of hospital stay (LOS) and one-year mortality. METHODS: Adult patients assessed preoperatively for pancreatoduodenectomy underwent computed tomography (CT) derived body composition analysis and handgrip strength (HGS) assessment. Sarcopenia was defined by the coexistence of low skeletal muscle index (SMI) and low HGS. Malnutrition was diagnosed using GLIM criteria incorporating muscle mass. Associations with postoperative LOS and one-year mortality were examined. RESULTS: Among 352 patients assessed preoperatively, 284 underwent pancreatoduodenectomy and were included in postoperative LOS analyses, while one-year mortality was assessed in 248 patients. Low HGS was present in 49% of patients, low SMI in 42%, sarcopenia in 21%, and GLIM-defined malnutrition in 83%. Neither sarcopenia nor GLIM-defined malnutrition was associated with LOS. On multivariable logistic regression adjusted for age, sex, body mass index, SMI, and sarcopenia, both low HGS (OR 4.4, 95% CI 1.6-12.6; p = 0.004) and GLIM-defined malnutrition (OR 3.99, 95% CI 1.01-15.87; p = 0.049) remained independently associated with one-year mortality. CONCLUSIONS: Low HGS and GLIM-defined malnutrition independently predicted one-year mortality, supporting the complementary value of objective muscle assessment alongside GLIM-defined malnutrition for perioperative risk stratification in patients undergoing pancreatoduodenectomy.