Functional Compromise Reflected by Sarcopenia, Frailty, and Nutritional Depletion Predicts Adverse Postoperative Outcome After Colorectal Cancer Surgery

Reisinger, Kostan W.; Vugt, Jeroen L.A. van; Tegels, Juul J. W.; Snijders, Claire; Hulsewé, Karel W. E.; Hoofwijk, A. G. M.; Stoot, Jan H.M.B.; Meyenfeldt, M.F. von; Beets, Geerard L.; Derikx, Joep P. M.; Poeze, Martijn

doi:10.1097/sla.0000000000000628

Cited by 443 publications

(359 citation statements)

References 37 publications

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“…Most studies were observational (23 of 35) with a total of 1 153 684 patients available for the analysis. Cohorts were composed of patients undergoing lower gastrointestinal (GI) surgery (10 studies), upper GI surgery (6), mixed GI surgery (4), gynaecological surgery (6), urological surgery (4) and mixed abdominal surgery (6) ( Table 1)1 12, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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“…Sarcopenia and myosteatosis have been significantly associated with a range of adverse outcomes including increased rate of post‐operative complications,10, 11, 40, 41, 42 longer length of hospital stay,41, 43 30‐day post‐operative mortality and in‐hospital mortality,44 and dose‐limiting toxicities 5, 6, 7, 8, 45, 46, 47, 48, 49, 50. In addition, the conditions have been demonstrated as independent predictors of reduced overall survival 18, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Bhuachalla

Daly

Power

et al. 2017

J cachexia sarcopenia muscle

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BackgroundNutrition screening on admission to hospital is mandated in many countries, but to date, there is no consensus on which tool is optimal in the oncology setting. Wasting conditions such as cancer cachexia (CC) and sarcopenia are common in cancer patients and negatively impact on outcomes; however, they are often masked by excessive adiposity. This study aimed to inform the application of screening in cancer populations by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients, including those with abnormal body composition phenotypes (CC, sarcopenia, and myosteatosis).MethodsA prospective study of ambulatory oncology outpatients presenting for chemotherapy was performed. A detailed survey incorporating clinical, nutritional, biochemical, and quality of life data was administered. Participants were screened for malnutrition using the Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and the Nutritional Risk Index (NRI). Computed tomography (CT) assessment of body composition was performed to diagnose CC, sarcopenia, and myosteatosis according to consensus criteria.ResultsA total of 725 patients (60% male, median age 64 years) with solid tumours participated (45% metastatic disease). The majority were overweight/obese (57%). However, 67% were losing weight, and CT analysis revealed CC in 42%, sarcopenia in 41%, and myosteatosis in 46%. Among patients with CT‐identified CC, the MUST, MST, and NRI tools categorized 27%, 35%, and 7% of them as ‘low nutritional risk’, respectively. The percentage of patients with CT‐identified sarcopenia and myosteatosis that were categorised as ‘low nutritional risk’ by MUST, MST and NRI were 55%, 61%, and 14% and 52%, 50%, and 11%, respectively. Among these tools, the NRI was most sensitive, with scores <97.5 detecting 85.8%, 88.6%, and 92.9% of sarcopenia, myosteatosis, and CC cases, respectively. Using multivariate Cox proportional hazards models, NRI score < 97.5 predicted greater mortality risk (hazard ratio 1.8, confidence interval: 1.2–2.8, P = 0.007).ConclusionsHigh numbers of nutritionally vulnerable patients, with demonstrated abnormal body composition phenotypes on CT analysis, were misclassified by MUST and MST. Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools. NRI detected the majority of abnormal body composition phenotypes and independently predicted survival. Of the tools examined, the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients.

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“…Computed tomography (CT) imaging has been most frequently used to predict preoperative sarcopenia and investigate the relationship between sarcopenia and postoperative outcomes. However, methods for evaluating total mass of the psoas [14][15][16][17], SM [11][12][13]31], or total volume of the psoas major [15] and cutoff points for sarcopenia differ across studies because of the difficulty in comparing sarcopenic candidates to healthy young adults in term of radiation exposure. How to best characterize sarcopenia remains to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we examined postoperative complications in more detail. Sarcopenia is not a predictor of anastomotic leakage [31], which is often a fatal SSI after resection of colorectal cancer. We showed that sarcopenia is not associated with SSIs including anastomotic leakage, pancreatic fistula, and intraabdominal abscess, but sarcopenia is associated with non-SSI complications, particularly pneumonia.…”

Section: Discussionmentioning

confidence: 99%

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Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy

et al. 2015

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Background Malignancy is a secondary cause of sarcopenia, which is associated with impaired cancer treatment outcomes. The aim of this study was to investigate the prevalence of preoperative sarcopenia among elderly gastric cancer patients undergoing gastrectomy and the differences in preoperative dietary intake and postoperative complications between sarcopenic and non-sarcopenic patients. Methods Ninety-nine patients over 65 years of age who underwent gastrectomy for gastric cancer were analyzed. All patients underwent gait and handgrip strength testing, and whole-body skeletal muscle mass was measured using a bioimpedance analysis technique based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm for the evaluation of sarcopenia before surgery. Preoperative dietary intake was assessed using a food frequency questionnaire. Results Of these patients, 21 (21.2 %) were diagnosed with sarcopenia. Sarcopenic patients consumed fewer calories and less protein preoperatively (23.9 vs. 27.8 kcal/ kg ideal weight/day and 0.86 vs. 1.04 g/kg ideal weight/-day; P = 0.001 and 0.0005, respectively). Although the overall incidence of postoperative complications was similar in the two groups (57.1 % vs. 35.9 %; P = 0.08), the incidence of severe (Clavien-Dindo grade C IIIa) complications was significantly higher in the sarcopenic group than in the non-sarcopenic group (28.6 % vs. 9.0 %; P = 0.029). In the multivariate analysis, sarcopenia alone was identified as a risk factor for severe postoperative complications (odds ratio, 4.76; 95 % confidence interval, 1.03-24.30; P = 0.046). Conclusions Preoperative sarcopenia as defined by the EWGSOP algorithm is a risk factor for severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

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Functional Compromise Reflected by Sarcopenia, Frailty, and Nutritional Depletion Predicts Adverse Postoperative Outcome After Colorectal Cancer Surgery

Cited by 443 publications

References 37 publications

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy

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