Der Einfluss von Kachexie und Sarkopenie auf das postoperative Outcome

Zusammenfassung

Kachexie wird als multifaktorielles Syndrom definiert, das durch einen unfreiwillig fortschreitenden Gewichtsverlust infolge einer Verringerung der Skelettmuskelmasse mit oder ohne Reduktion des Fettgewebes gekennzeichnet ist. Der Abbau von Muskelgewebe wird als Sarkopenie bezeichnet. Diese wird klinisch als Verlust von Muskelmasse und/oder Muskelkraft definiert, wobei der Verlust von Muskelkraft im Vordergrund steht. Mit Sarkopenie verbunden ist der Zustand der Myosteatose, der durch eine Zunahme der intra- und extrazellulären Fettspeicher gekennzeichnet ist und mit einer verminderten Muskelfunktion einhergeht. Kachexie ist für den Tod von mindestens 20% aller Krebspatienten mitverantwortlich. Die Inzidenz variiert bei diesen Patienten je nach Art der Erkrankung zwischen 80% für Patienten mit Magen- und Bauchspeicheldrüsenkrebs, 50% für Patienten mit Lungen-, Dickdarm- und Prostatakrebs sowie etwa 40% für Patienten mit Brustkrebs oder Leukämie. Hierbei ist eine Unterscheidung zwischen tumorassoziierter Kachexie und einer durch Nebenwirkungen und Komplikationen der onkologischen Therapie bedingten Kachexie oft schwierig. Das wesentliche klinische Merkmal der Kachexie ist ein unfreiwilliger Gewichtsverlust, der sich jedoch nicht immer klinisch manifestiert, sodass die Identifizierung von Risikopatienten erheblich erschwert ist. Nicht nur das Langzeit-Outcome der Patienten wird von Kachexie und Sarkopenie beeinflusst. Auch die unmittelbaren postoperativen Komplikationsraten (Morbidität) werden erhöht und haben tiefgreifende Auswirkungen auf die Krankheitslast und das Leiden der Patienten nach einer chirurgischen Behandlung. Kachexie, Sarkopenie und Myosteatose sind somit für den klinischen Alltag hochrelevante Parameter, die einen signifikanten Einfluss auf das postoperative Outcome der Patienten haben. Es wurden verschiedene Methoden entwickelt, um die frühzeitige Identifizierung von Patienten mit einem erhöhten Risiko zu verbessern. Diese bieten die Möglichkeit, ungewollten Gewichtsverlust, verringerte Muskelkraft und die Fitness der Patienten zu testen. Derartige Maßnahmen sollten Teil unserer täglichen klinischen Routine werden, um diejenigen Patienten mit dem höchsten postoperativen Risiko zu erkennen. Entsprechend können neuartige Präkonditionierungskonzepte für bestimmte Patientengruppen in der Lage sein, die postoperative Morbidität zu verringern.

Abstract

Cachexia is defined as a multifactorial syndrome characterised by involuntary progressive weight loss due to a decrease in skeletal muscle mass, with or without a reduction in adipose tissue. The breakdown of muscle tissue is known as sarcopenia. This is clinically defined as loss of muscle mass and/or muscle strength, with loss of muscle strength being more important than muscle mass. Cachexia is responsible for the death of at least 20% of all cancer patients. The incidence in these patients varies, depending on the type of disease, between 80% for patients with gastric and pancreatic cancer, 50% for patients with lung, colon and prostate cancer, and about 40% for patients with breast cancer or leukemia. It is often difficult to distinguish between tumour-associated cachexia and cachexia caused by side effects and complications of oncological therapy. The main clinical feature of cachexia is involuntary weight loss, but this does not always manifest itself clinically, making it much more difficult to identify patients at risk. Not only the long-term outcome of the patient is influenced by cachexia and sarcopenia. Immediate postoperative complication rates (morbidity) are also increased and have profound effects on the burden of disease and the suffering of patients after surgical treatment. Cachexia, sarcopenia and myosteatosis are therefore highly relevant parameters for everyday clinical practice, which have a significant influence on the postoperative outcome of the patient. Several tools have been developed to aid the identification of patients with nutritional risk, i.e. involuntary weight loss, reduced muscle strength and physical condition. Such measures should be a part of our daily clinical routine to ensure the identification of patients with the highest postoperative risk. Novel preconditioning treatment may be beneficial to certain patient groups to reduce postoperative morbidity.

Schlüsselwörter

Abdominalchirurgie - Sarkopenie - Kachexie - postoperative Morbidität - onkologisches Outcome

Key words

sarcopenia - cachexia - abdominal surgery - postoperative morbidity - oncological outcome

Publication History

Article published online:
21 June 2021

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