human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Despite the positive survival results of cytoreductive surgery ( CRS ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) , criticisms have been put forward regarding the safety of this treatment as a result of a high morbidity rate . Muscle depletion ( sarcopenia ) is associated with the occurrence of postoperative complications . The purpose of this study was to determine the association between sarcopenia and postoperative morbidity after  CRS-HIPEC for peritoneal carcinomatosis from colorectal cancer by distinguishing the complications linked to CRS itself and those associated with chemotherapy ( HIPEC ) toxicities . Methods Data concerning 97 consecutive patients who had undergone CRS-HIPEC were recorded . We analyzed the events occurring within 30 days after surgery that were prospect ively recorded in a data base . Sarcopenia was assessed using the L3 muscle index on computed tomography performed during the 2 months preceding surgery . Results The sarcopenic patients experienced significantly more chemotherapy toxicities ( 57 vs. 26 % ; p = 0.004 ) and especially neutropenia ( 36 vs. 17 % ; p = 0.04 ) than their nonsarcopenic counterparts . There was no difference in complications linked to the CRS procedure between sarcopenic and nonsarcopenic patients . In the multivariate analysis , sarcopenia was the only parameter independently associated with the risk of chemotherapy toxicity ( odds ratio 3.97 ; 95 % confidence interval 1.52–10.39 ; p = 0.005 ) . Conclusions Despite the local administration of chemotherapy , systemic toxicity was observed in sarcopenic patients after CRS-HIPEC . This relationship favors new treatment strategies with white blood cell growth factors or chemotherapy dosing based on muscle value Objective : The aim of this article was to study the prevalence and significance of sarcopenia in the multimodal management of locally advanced esophageal cancer ( LAEC ) , and to assess its independent impact on operative and oncologic outcomes . Summary of Background Data : Sarcopenia in cancer may confer negative outcomes , but its prevalence and impact on modern multimodal regimens for LAEC have not been systematic ally studied . Methods : Two hundred fifty-two consecutive patients were studied .  Lean body mass ( LBM ) , skeletal muscle index ( SMI ) , and fat mass ( FM ) were determined pre-treatment , preoperatively , and 1 year postoperatively . Sarcopenia was defined by computed tomography ( CT ) at L3 as SMI < 52.4 cm2/m2 for males and SMI < 38.5 cm2/m2 for females . All complications were recorded prospect ively , including comprehensive complications index ( CCI ) , Clavien-Dindo complication ( CDC ) , and pulmonary complications ( PPCs ) . Multivariable linear , logistic , and Cox regression analysis was performed . Results : In-hospital mortality was 1 % , and CCI was 21 ± 19 . Sarcopenia increased ( P = 0.02 ) from 16 % at diagnosis to 31 % post-neoadjuvant therapy , with loss of LBM ( -3.0 ± 5.4 kg , P < 0.0001 ) , but not FM ( -0.3 ± 2.7 kg , P= 0.31 ) during treatment . On multivariable analysis , preoperative sarcopenia was associated with CCI ( P = 0.043 ) , and CDC ≥IIIb ( P = 0.003 ) . PPCs occurred in 36 % nonsarcopenic versus 55 % sarcopenic patients ( P = 0.01 ) . Sarcopenia did not impact disease-specific ( P = 0.14 ) or overall survival ( P = 0.11 ) after resection . At 1 year , 35 % had sarcopenia , significantly associated with pre-treatment BMI ( P = 0.013 ) but not complications ( P = 0.20 ) . Conclusions : Sarcopenia increases through multimodal therapy , is associated with an increased risk of major postoperative complications , and is prevalent in survivorship . These data highlight a potentially modifiable marker of risk that should be assessed and targeted in modern multimodal care pathways Background This study aim ed to determine the relationship between intra-abdominal infection ( IAI ) and sarcopenia prospect ively and to construct a nomogram to identify patients at a high risk of IAI . Methods We conducted a prospect i ve study of 682 consecutive patients with gastric cancer who underwent radical gastrectomy .  The sarcopenia elements , including lumbar skeletal muscle index , h and grip strength , and gait speed , were measured before surgery . Factors contributing to IAI were determined through univariate and multivariate analysis . A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of IAI . Results Of the 682 patients enrolled in this study , 132 patients were diagnosed with sarcopenia and 61 were diagnosed with IAI . Logistic analysis revealed that sarcopenia , tumor size , pathological type , and multivisceral resection were independent prognostic factors for IAI . The nomogram model for IAI was able to reliably quantify the risk of IAI with a strong optimism-adjusted discrimination ( concordance index , 0.736 ) . Conclusions Sarcopenia is an independent predictor of IAI . Our nomogram was a simple and practical instrument to quantify the individual risk of IAI and could be used to identify patients at a high risk Background / objectives The aim of this study was to examine the impact of visceral fat on surgical complications and long-term survival for patients undergoing radical gastrectomy . Subjects/ methods From 2009 to 2013 , 859 patients who underwent curative resection for gastric cancer were enrolled from a prospect ively maintained data base .  Visceral fat area ( VFA ) was assessed by preoperative CT scans . Patients were divided into two groups by VFA .  Perioperative variables and postoperative outcomes were compared between the high VFA group and low VFA group . Univariable and multivariable analysis were performed to investigate independent risk factors of postoperative complications and survival . Results Some 859 patients were included in the study , 308 of whom were classified as high VFA . High VFA was correlated with advance age ( P = 0.020 ) , higher albumin levels ( P = 0.001 ) , hemoglobin levels ( P < 0.05 ) , ASA grade ( P = 0.043 ) and Charlson Comorbidity Index ( P = 0.004 ) . Relative to patients with low VFA , those with high VFA had longer surgical duration s ( P = 0.004 ) , higher rate of postoperative complications ( P = 0.004 ) , and longer hospital stays ( P = 0.004 ) . High VFA was identified as the only determinant for surgical complications by logistic regression analysis ( OR , 2.236 , 95 % CI , 1.537–3.254 ; P < 0.001 ) . Cox proportional hazards regression revealed no correlation between VFA and overall survival ( OS ) or disease-free survival ( DFS ) . Conclusions Increased VFA independently predicts surgical complications in patients after gastrectomy . However , VFA is not a prognostic biomarker of OS or DFS in patients with gastric cancer BACKGROUND & AIMS Profound weight loss and malnutrition subsequent to severe dysphagia and cancer cachexia are cardinal symptoms in oesophageal cancer ( OC ) . Low muscle mass/sarcopenia has been linked to toxicity during neo-adjuvant therapy in other cancers , with worser effects in sarcopenic obesity . In this study the association between sarcopenia and /or sarcopenic obesity and dose limiting toxicity ( DLT ) during cycle one chemotherapy in resectable OC patients was evaluated . METHODS Body composition was assessed from computed tomography scans of 72 consecutively diagnosed OC patients . Lean body mass and body fat mass were estimated . Patients were grouped as sarcopenic or non-sarcopenic based on pre-defined gender-specific cut-offs for sarcopenia , and as underweight/normal ( BMI < 25 ) or overweight/obese ( BMI ≥ 25 ) . Sarcopenic obesity was defined as sarcopenia combined with overweight and obesity . DLT was defined as temporary reduction/delay or permanent discontinuation of drugs due to adverse effects . Odds ratios for developing toxicity were ascertained using multiple logistic regression . RESULTS Of 72 patients , 85 % ( n = 61 ) were males . Sarcopenia and sarcopenic obesity were present in 31 ( 43 % ) and 10 ( 14 % ) , respectively , prior to chemotherapy . Sarcopenic patients had significantly lower adipose tissue index ( p = 0.02 ) compared to non-sarcopenic patients . Patients with DLT ( n = 24 ) had lower skeletal muscle mass ( p = 0.04 ) than those without DLT . Sarcopenic patients ( OR = 2.47 ; 95 % CI : 0.88 - 6.93 ) showed a trend towards increased DLT risk ( p < 0.10 ) . Logistic regression with BMI as an interaction term indicated higher DLT risk in sarcopenic patients with normal BMI ( OR = 1.60 ; 95 % CI 0.30 - 8.40 ) , but was non-significant . In the sarcopenic obese , risk of DLT increased significantly ( OR = 5.54 ; 95 % CI 1.12 - 27.44 ) . CONCLUSIONS Sarcopenic and sarcopenic obese OC patients may be at a higher risk for developing DLT during chemotherapy compared to non-sarcopenic OC patients Background With the increased prevalence of obesity and sarcopenia , those patients with both visceral obesity and sarcopenia were at higher risk of adverse outcomes . Aim The aim of this study was to ascertain the combined impact of visceral obesity and sarcopenia on short-term outcomes in patients undergoing colorectal cancer surgery . Methods We conducted a prospect i ve study from July 2014 to February 2017 . Patients ’ demographic , clinical characteristics , physical performance , and postoperative short-term outcomes were collected . Patients were classified into four groups according to the presence of sarcopenia or visceral obesity . Clinical variables were compared . Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed . Results A total of 376 patients were included ; 50.8 and 24.5 % of the patients were identified as having “ visceral obesity ” and “ sarcopenia , ” respectively . Patients with sarcopenia and visceral obesity had the highest incidence of total , surgical , and medical complications . Patients with sarcopenia or/ and visceral obesity all had longer hospital stays and higher hospitalization costs . Age ≥ 65 years , visceral obesity , and sarcopenia were independent risk factors for total complications . Rectal cancer and visceral obesity were independent risk factors for surgical complications . Age ≥ 65 years and sarcopenia were independent risk factors for medical complications .  Laparoscopy-assisted operation was a protective factor for total and medical complications . Conclusion Patients with both visceral obesity and sarcopenia had a higher complication rate after colorectal cancer surgery . Age ≥ 65 years , visceral obesity , and sarcopenia were independent risk factors for total complications . Laparoscopy-assisted operation was a protective factor BACKGROUND Computed tomography ( CT ) can be used for accurate estimation of whole-body muscle mass and muscle density and for detection of sarcopenia . The goal of this study was to evaluate the additional value of CT measured sarcopenia and muscle attenuation alongside the Malnutrition Universal Screening Tool ( MUST ) for the prediction of post-operative morbidity after oncological colorectal resection , whilst correcting for known risk factors . METHODS A prospect i ve cohort study of 80 patients undergoing elective colorectal surgery in the Netherl and s. Patients were screened for nutritional risk upon admission using the MUST . Additionally , preoperative CT scans were used to determine skeletal muscle mass for the detection of sarcopenia and muscle attenuation . Univariate and multivariable analyses were performed to evaluate associations between the MUST , muscle attenuation and sarcopenia on the one h and and post-operative complications measured by the Clavien-Dindo score on the other h and . RESULTS American Society of Anesthesiology-classification ( ASA ) ≥3 , age ≥70 , MUST ≥2 and lower than median muscle attenuation were significantly associated with a higher risk for postoperative complications ( Clavien-Dindo score ≥2 ) ( p ≤ 0.05 ) , whereas sarcopenia was not ( p = 0.59 ) . Multivariate analyses showed that only MUST ≥2 remained significantly associated with postoperative complications when corrected for age ( p = 0.03 , OR 5.8 , 95%CI 1.1 - 29.6 ) , but not when corrected for age ≥70 and ASA ≥3 . Muscle attenuation and sarcopenia were not significantly associated with postoperative complications . CONCLUSION Our results suggest that using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery . It also underlines the importance of currently implemented easy-to 
    Output:
    
agent
Conclusion The prevalence of sarcopenia depends mostly on the diagnostic cut-off points of different criteria .
Preoperative sarcopenia is a risk factor for both long-term and short-term outcomes
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Despite the positive survival results of cytoreductive surgery ( CRS ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) , criticisms have been put forward regarding the safety of this treatment as a result of a high morbidity rate . Muscle depletion ( sarcopenia ) is associated with the occurrence of postoperative complications . The purpose of this study was to determine the association between sarcopenia and postoperative morbidity after  CRS-HIPEC for peritoneal carcinomatosis from colorectal cancer by distinguishing the complications linked to CRS itself and those associated with chemotherapy ( HIPEC ) toxicities . Methods Data concerning 97 consecutive patients who had undergone CRS-HIPEC were recorded . We analyzed the events occurring within 30 days after surgery that were prospect ively recorded in a data base . Sarcopenia was assessed using the L3 muscle index on computed tomography performed during the 2 months preceding surgery . Results The sarcopenic patients experienced significantly more chemotherapy toxicities ( 57 vs. 26 % ; p = 0.004 ) and especially neutropenia ( 36 vs. 17 % ; p = 0.04 ) than their nonsarcopenic counterparts . There was no difference in complications linked to the CRS procedure between sarcopenic and nonsarcopenic patients . In the multivariate analysis , sarcopenia was the only parameter independently associated with the risk of chemotherapy toxicity ( odds ratio 3.97 ; 95 % confidence interval 1.52–10.39 ; p = 0.005 ) . Conclusions Despite the local administration of chemotherapy , systemic toxicity was observed in sarcopenic patients after CRS-HIPEC . This relationship favors new treatment strategies with white blood cell growth factors or chemotherapy dosing based on muscle value Objective : The aim of this article was to study the prevalence and significance of sarcopenia in the multimodal management of locally advanced esophageal cancer ( LAEC ) , and to assess its independent impact on operative and oncologic outcomes . Summary of Background Data : Sarcopenia in cancer may confer negative outcomes , but its prevalence and impact on modern multimodal regimens for LAEC have not been systematic ally studied . Methods : Two hundred fifty-two consecutive patients were studied .  Lean body mass ( LBM ) , skeletal muscle index ( SMI ) , and fat mass ( FM ) were determined pre-treatment , preoperatively , and 1 year postoperatively . Sarcopenia was defined by computed tomography ( CT ) at L3 as SMI < 52.4 cm2/m2 for males and SMI < 38.5 cm2/m2 for females . All complications were recorded prospect ively , including comprehensive complications index ( CCI ) , Clavien-Dindo complication ( CDC ) , and pulmonary complications ( PPCs ) . Multivariable linear , logistic , and Cox regression analysis was performed . Results : In-hospital mortality was 1 % , and CCI was 21 ± 19 . Sarcopenia increased ( P = 0.02 ) from 16 % at diagnosis to 31 % post-neoadjuvant therapy , with loss of LBM ( -3.0 ± 5.4 kg , P < 0.0001 ) , but not FM ( -0.3 ± 2.7 kg , P= 0.31 ) during treatment . On multivariable analysis , preoperative sarcopenia was associated with CCI ( P = 0.043 ) , and CDC ≥IIIb ( P = 0.003 ) . PPCs occurred in 36 % nonsarcopenic versus 55 % sarcopenic patients ( P = 0.01 ) . Sarcopenia did not impact disease-specific ( P = 0.14 ) or overall survival ( P = 0.11 ) after resection . At 1 year , 35 % had sarcopenia , significantly associated with pre-treatment BMI ( P = 0.013 ) but not complications ( P = 0.20 ) . Conclusions : Sarcopenia increases through multimodal therapy , is associated with an increased risk of major postoperative complications , and is prevalent in survivorship . These data highlight a potentially modifiable marker of risk that should be assessed and targeted in modern multimodal care pathways Background This study aim ed to determine the relationship between intra-abdominal infection ( IAI ) and sarcopenia prospect ively and to construct a nomogram to identify patients at a high risk of IAI . Methods We conducted a prospect i ve study of 682 consecutive patients with gastric cancer who underwent radical gastrectomy .  The sarcopenia elements , including lumbar skeletal muscle index , h and grip strength , and gait speed , were measured before surgery . Factors contributing to IAI were determined through univariate and multivariate analysis . A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of IAI . Results Of the 682 patients enrolled in this study , 132 patients were diagnosed with sarcopenia and 61 were diagnosed with IAI . Logistic analysis revealed that sarcopenia , tumor size , pathological type , and multivisceral resection were independent prognostic factors for IAI . The nomogram model for IAI was able to reliably quantify the risk of IAI with a strong optimism-adjusted discrimination ( concordance index , 0.736 ) . Conclusions Sarcopenia is an independent predictor of IAI . Our nomogram was a simple and practical instrument to quantify the individual risk of IAI and could be used to identify patients at a high risk Background / objectives The aim of this study was to examine the impact of visceral fat on surgical complications and long-term survival for patients undergoing radical gastrectomy . Subjects/ methods From 2009 to 2013 , 859 patients who underwent curative resection for gastric cancer were enrolled from a prospect ively maintained data base .  Visceral fat area ( VFA ) was assessed by preoperative CT scans . Patients were divided into two groups by VFA .  Perioperative variables and postoperative outcomes were compared between the high VFA group and low VFA group . Univariable and multivariable analysis were performed to investigate independent risk factors of postoperative complications and survival . Results Some 859 patients were included in the study , 308 of whom were classified as high VFA . High VFA was correlated with advance age ( P = 0.020 ) , higher albumin levels ( P = 0.001 ) , hemoglobin levels ( P < 0.05 ) , ASA grade ( P = 0.043 ) and Charlson Comorbidity Index ( P = 0.004 ) . Relative to patients with low VFA , those with high VFA had longer surgical duration s ( P = 0.004 ) , higher rate of postoperative complications ( P = 0.004 ) , and longer hospital stays ( P = 0.004 ) . High VFA was identified as the only determinant for surgical complications by logistic regression analysis ( OR , 2.236 , 95 % CI , 1.537–3.254 ; P < 0.001 ) . Cox proportional hazards regression revealed no correlation between VFA and overall survival ( OS ) or disease-free survival ( DFS ) . Conclusions Increased VFA independently predicts surgical complications in patients after gastrectomy . However , VFA is not a prognostic biomarker of OS or DFS in patients with gastric cancer BACKGROUND & AIMS Profound weight loss and malnutrition subsequent to severe dysphagia and cancer cachexia are cardinal symptoms in oesophageal cancer ( OC ) . Low muscle mass/sarcopenia has been linked to toxicity during neo-adjuvant therapy in other cancers , with worser effects in sarcopenic obesity . In this study the association between sarcopenia and /or sarcopenic obesity and dose limiting toxicity ( DLT ) during cycle one chemotherapy in resectable OC patients was evaluated . METHODS Body composition was assessed from computed tomography scans of 72 consecutively diagnosed OC patients . Lean body mass and body fat mass were estimated . Patients were grouped as sarcopenic or non-sarcopenic based on pre-defined gender-specific cut-offs for sarcopenia , and as underweight/normal ( BMI < 25 ) or overweight/obese ( BMI ≥ 25 ) . Sarcopenic obesity was defined as sarcopenia combined with overweight and obesity . DLT was defined as temporary reduction/delay or permanent discontinuation of drugs due to adverse effects . Odds ratios for developing toxicity were ascertained using multiple logistic regression . RESULTS Of 72 patients , 85 % ( n = 61 ) were males . Sarcopenia and sarcopenic obesity were present in 31 ( 43 % ) and 10 ( 14 % ) , respectively , prior to chemotherapy . Sarcopenic patients had significantly lower adipose tissue index ( p = 0.02 ) compared to non-sarcopenic patients . Patients with DLT ( n = 24 ) had lower skeletal muscle mass ( p = 0.04 ) than those without DLT . Sarcopenic patients ( OR = 2.47 ; 95 % CI : 0.88 - 6.93 ) showed a trend towards increased DLT risk ( p < 0.10 ) . Logistic regression with BMI as an interaction term indicated higher DLT risk in sarcopenic patients with normal BMI ( OR = 1.60 ; 95 % CI 0.30 - 8.40 ) , but was non-significant . In the sarcopenic obese , risk of DLT increased significantly ( OR = 5.54 ; 95 % CI 1.12 - 27.44 ) . CONCLUSIONS Sarcopenic and sarcopenic obese OC patients may be at a higher risk for developing DLT during chemotherapy compared to non-sarcopenic OC patients Background With the increased prevalence of obesity and sarcopenia , those patients with both visceral obesity and sarcopenia were at higher risk of adverse outcomes . Aim The aim of this study was to ascertain the combined impact of visceral obesity and sarcopenia on short-term outcomes in patients undergoing colorectal cancer surgery . Methods We conducted a prospect i ve study from July 2014 to February 2017 . Patients ’ demographic , clinical characteristics , physical performance , and postoperative short-term outcomes were collected . Patients were classified into four groups according to the presence of sarcopenia or visceral obesity . Clinical variables were compared . Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed . Results A total of 376 patients were included ; 50.8 and 24.5 % of the patients were identified as having “ visceral obesity ” and “ sarcopenia , ” respectively . Patients with sarcopenia and visceral obesity had the highest incidence of total , surgical , and medical complications . Patients with sarcopenia or/ and visceral obesity all had longer hospital stays and higher hospitalization costs . Age ≥ 65 years , visceral obesity , and sarcopenia were independent risk factors for total complications . Rectal cancer and visceral obesity were independent risk factors for surgical complications . Age ≥ 65 years and sarcopenia were independent risk factors for medical complications .  Laparoscopy-assisted operation was a protective factor for total and medical complications . Conclusion Patients with both visceral obesity and sarcopenia had a higher complication rate after colorectal cancer surgery . Age ≥ 65 years , visceral obesity , and sarcopenia were independent risk factors for total complications . Laparoscopy-assisted operation was a protective factor BACKGROUND Computed tomography ( CT ) can be used for accurate estimation of whole-body muscle mass and muscle density and for detection of sarcopenia . The goal of this study was to evaluate the additional value of CT measured sarcopenia and muscle attenuation alongside the Malnutrition Universal Screening Tool ( MUST ) for the prediction of post-operative morbidity after oncological colorectal resection , whilst correcting for known risk factors . METHODS A prospect i ve cohort study of 80 patients undergoing elective colorectal surgery in the Netherl and s. Patients were screened for nutritional risk upon admission using the MUST . Additionally , preoperative CT scans were used to determine skeletal muscle mass for the detection of sarcopenia and muscle attenuation . Univariate and multivariable analyses were performed to evaluate associations between the MUST , muscle attenuation and sarcopenia on the one h and and post-operative complications measured by the Clavien-Dindo score on the other h and . RESULTS American Society of Anesthesiology-classification ( ASA ) ≥3 , age ≥70 , MUST ≥2 and lower than median muscle attenuation were significantly associated with a higher risk for postoperative complications ( Clavien-Dindo score ≥2 ) ( p ≤ 0.05 ) , whereas sarcopenia was not ( p = 0.59 ) . Multivariate analyses showed that only MUST ≥2 remained significantly associated with postoperative complications when corrected for age ( p = 0.03 , OR 5.8 , 95%CI 1.1 - 29.6 ) , but not when corrected for age ≥70 and ASA ≥3 . Muscle attenuation and sarcopenia were not significantly associated with postoperative complications . CONCLUSION Our results suggest that using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery . It also underlines the importance of currently implemented easy-to 
    Output:
    