Preoperative low skeletal muscle mass index assessed using L3-CT as a prognostic marker of clinical outcomes in pancreatic cancer patients undergoing surgery: A systematic review and meta-analysis.

Background: Reduction in muscle mass can be routinely quantified using computed tomography (CT) of the third lumbar vertebra (L3) during a curative pancreatic cancer (PC) course. This systematic review and meta-analysis aimed to assess the association between preoperative low skeletal muscle index (SMI) measured by L3 CT and postoperative clinical outcomes in PC resectable patients. Methods: Three electronic databases (PubMed, Web of Science, and Scopus) were searched for articles published through May 2023. Duplicate titles and abstracts, full-text screening, and data extraction were performed. A meta-analysis was performed for overall survival (OS), recurrence-free survival (RFS), postoperative pancreatic fistula (POPF), morbidity, and postoperative length of stay (P-LOS). The risk of bias was assessed. Results: A total of 2942 patients with PC from 11 studies were identified. Preoperative low SMI was found in 50.9% of PC resectable patients. Preoperative low SMI was significantly associated with adjusted OS (adjusted HR, 1.52; 95% CI 1.25-1.86, p< 0.0001). No significant associations were found between preoperative low SMI and RFS, number of POPF, significant morbidity, and P-LOS (p>0.05). Conclusions: SMI should be evaluated in a timely manner as a predictor of OS in PC resectable patients. Studies assessing nutritional protocols for maintaining/increasing skeletal muscle mass are required to develop a personalized nutritional approach to improve clinical outcomes