Impact of myopenia and myosteatosis on postoperative outcome and recurrence in Crohn’s disease

Abstract

Purpose Myopenia and myosteatosis have been proposed to be prognostic factors of surgical outcomes for various diseases, but their exact role in Crohn’s disease (CD) is unknown. The aim of this study is to evaluate their impact on anastomotic leakage, CD recurrence, and postoperative complications after ileocecal resection in patients with CD. Methods A retrospective analysis of CD patients undergoing ileocecal resection at our tertiary referral center was performed. To assess myopenia, skeletal muscle index (skeletal muscle area normalized for body height) was measured using an established image analysis method at third lumbar vertebra level on MRI cross-sectional images. Muscle signal intensity was measured to assess myosteatosis index. Results A total of 347 patients were retrospectively analyzed. An adequate abdominal MRI scan within 12 months prior to surgery was available for 223 patients with median follow-up time of 48.8 months (IQR: 20.0–82.9). Anastomotic leakage rate was not associated with myopenia (SMI: p = 0.363) or myosteatosis index (p = 0.821). Patients with Crohn’s recurrence had a significantly lower SMI (p = 0.047) in univariable analysis, but SMI was not an independent factor for recurrent anastomotic stenosis in multivariable analysis (OR 0.951, 95% CI 0.840–1.078; p = 0.434). Postoperative complications were not associated with myopenia or myosteatosis. Conclusion Based on the largest cohort of its kind with a long follow-up time, we could provide some data that MRI parameters for myopenia and myosteatosis may not be reliable predictors of postoperative outcome or recurrence in patients with Crohn’s disease undergoing ileocecal resection.

Review article: Putting some muscle into sarcopenia—the pathogenesis, assessment and clinical impact of muscle loss in patients with inflammatory bowel disease

“…47 In contrast, in a retrospective study evaluating the impact of muscle health on post-operative outcomes in patients with CD undergoing ileocecal resection, patients with post-operative recurrence had a significantly lower skeletal muscle mass index (p = 0.047) compared to those without disease recurrence, however, sarcopenia was not associated with anastomotic stenosis or other post-operative complications (Table 1). 51…”

Role of visceral fat on postoperative complications and relapse in patients with Crohn's disease after ileocecal resection: Is it overrated?

“…Recent studies have demonstrated the accurate measurement and quantification of adipose tissue distribution, particularly the “visceral fat area” (VFA), and muscle mass to assess the grade of myopenia using computed tomography (CT) or magnetic resonance imaging (MRI), and the strong correlation with the visceral fat mass [ 13 – 15 ].…”

Prognostic impact of myosteatosis in patients with colorectal cancer undergoing curative surgery: an updated systematic review and meta-analysis

“…Myosteatosis is often associated with the sarcopenia (i.e., reduction in skeletal muscle mass) and has been associated with adverse outcomes in patients with various cancers, including increased treatment-related toxicity, impaired functional status, increased postoperative infectious complications, worse oncological outcomes, reduced quality of life, and diminished overall survival (OS) ( 4 , 7 – 10 ). In patients undergoing colorectal surgeries, including those with Crohn’s disease, myosteatosis has been linked to an increased risk of postoperative complications, such as surgical site infections and anastomotic leaks ( 11 ). Preoperative myosteatosis has been associated with adverse effect on short- and long-term outcomes in patients with CRC undergoing surgical resection ( 12 ).…”