(P08-025-23) Perioperative Glutamine Supplementation May Restore Atrophy of Psoas Muscles in Gastric Adenocarcinoma Patients Undergoing Gastrectomy

Objectives: Sarcopenia is characterized by the degenerative loss of skeletal muscles and has been increasingly associated with adverse surgical outcomes. Glutamine is considered an immune-modulating formula, which may stimulate protein synthesis in the skeletal muscles and inhibit protein degradation. The present study aims to investigate whether perioperative glutamine supplementation restores the atrophy of psoas muscle. To evaluate the atrophy restoration we have examined the psoas major muscle area (PMMA) of the third lumbar vertebra as the reference skeletal muscle.

Methods: Gastric adenocarcinoma (GA) patients undergoing gastrectomy were enrolled as subjects for investigation. Computed tomography (CT) was used to assess the short axis of the psoas muscle. The change observed between the scans from the preoperative day and three months post gastrectomy was used to estimate the muscle condition/atrophy. Subjects were prescribed with perioperative glutamine supplementation (PGS) for five-day parenteral plus one-month oral use. Propensity score (PS) matching was included to minimize the potential bias. A linear regression model was used to predict this association.

Results: 516 patients were included in the analysis from 2016 to 2019, 100 (19.4%) subjects received PGS. After PS matching, there were 97 cases in each group. The median change in PMMA index in the glutamine group (group receiving PGS) was significantly higher than that in the non-glutamine group (0.3 vs −0.3 cm2/m2, P = 0.004). On a multivariate analysis, PGS was significantly associated with increased PMMA index (coefficient = 0.60; 95% CI: 0.19–1.01; P = 0.005).

Conclusions: The PGS may restore the atrophy in psoas muscle among GA patients undergoing gastrectomy.

Prospective randomized and blinded studies are needed to confirm the present findings.

Funding Sources: This study was supported by grants (numbers 109-2221-E-002 -174 & 110-2221-E-002 -014 -MY3) from the Ministry of Science and Technology, which had no role in the study design, data collection, or analysis; decision to publish; or preparation of the manuscript.