Is radiological psoas muscle area measurement a predictor of postoperative complications after rectal resection for rectal cancer? A retrospective study

Uehara, Hiroaki; Yamazaki, Toshiyuki; Iwaya, Akira; Kameyama, Hitoshi; Utsumi, Shiori; Harada, Rina; Komatsu, Masaru; Hirai, Makoto; Kubota, Akira; Katada, Tomohiro; Kobayashi, Kazuo; Sato, Daisuke; Yokoyama, Naoyuki; Kuwabara, Shirou; Otani, Tetsuya

doi:10.1007/s00595-021-02346-x

Cited by 14 publications

(9 citation statements)

References 30 publications

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“…PMA and PMI have also been validated by multiple authors, and their predictive value for perioperative complications has been demonstrated in various patient cohorts, including colorectal cancer patients, liver cirrhosis patients and patients with acute pancreatitis [ 10 , 11 , 13 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

The role of sarcopenia in fragility fractures of the pelvis – is sarcopenia an underestimated risk factor?

Mair,

Neumann,

Rittstieg

et al. 2024

BMC Geriatr

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Background Fragility fractures of the pelvis (FFPs) represent a significant health burden, particularly for the elderly. The role of sarcopenia, an age-related loss of muscle mass and function, in the development and impact of these fractures is not well understood. This study aims to investigate the prevalence and impact of osteoporosis and sarcopenia in patients presenting with FFPs. Methods This retrospective study evaluated 140 elderly patients with FFPs. The diagnosis of sarcopenia was assessed by psoas muscle area (PMA) and the height-adjusted psoas muscle index (PMI) measured on computed tomography (CT) scans. Clinical data, radiological findings and functional outcomes were recorded and compared with the presence or absence of sarcopenia and osteoporosis. Results Our study cohort comprised 119 female (85.0%) and 21 (15.0%) male patients. The mean age at the time of injury or onset of symptoms was 82.26 ± 8.50 years. Sarcopenia was diagnosed in 68.6% (n = 96) patients using PMA and 68.8% (n = 88) using PMI. 73.6% (n = 103) of our study population had osteoporosis and 20.0% (n = 28) presented with osteopenia. Patients with sarcopenia and osteoporosis had longer hospital stays (p < 0.04), a higher rate of complications (p < 0.048) and functional recovery was significantly impaired, as evidenced by a greater need for assistance in daily living (p < 0.03). However, they were less likely to undergo surgery (p < 0.03) and the type of FFP differed significantly (p < 0.04). There was no significant difference in mortality rate, pre-hospital health status, age or gender. Conclusion Our study highlights the important role of sarcopenia in FFPs in terms of the serious impact on health and quality of life in elderly patients especially when osteoporosis and sarcopenia occur together. Identifying and targeting sarcopenia in older patients may be an important strategy to reduce pelvic fractures and improve recovery. Further research is needed to develop effective prevention and treatment approaches that target muscle health in the elderly.

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Section: Discussionmentioning

confidence: 99%

The role of sarcopenia in fragility fractures of the pelvis – is sarcopenia an underestimated risk factor?

Mair,

Neumann,

Rittstieg

et al. 2024

BMC Geriatr

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“…Új prognosztikai faktorok meghatározása szükséges a prognózis javítása és a helyes alstádiumokba való beosztás céljából [7,8]. Az időskorúak sarcopeniájával foglalkozó európai munkacsoport (European Working Group on Sarcopenia in Older People) javaslata szerint a sarcopenia a vázizomzat tömegének, erejének, funkciójának fokozatos és kiterjedt leépülését jelzi [7,9,10,11,12,13,14]. A sarcopeniának primer és secunder típusa ismeretes, amely szerint a primer esetek csupán az életkorral hozhatók összefüggésbe, míg a secunder esetek kapcsolatot mutatnak különböző malignus daganatokkal, krónikus és gyulladásos betegségekkel, valamint az alultápláltsággal [7,15,16].…”

Section: Bevezetésunclassified

“…A sarcopenia alapvetően az izomfehérje-forgalom egyensúlyzavarának eredménye [15]. A sarcopenia mértéke egyszerűen megállapítható képalkotó eljárások segítségével, leggyakrabban compu-ter tomográfiával (CT), amely a "gold standard" vizsgálatot, valamint a sarcopenia objektív képalkotó markerét képviseli [11,14,17]. A psoas izomtömeg indexe (PII) tükrözi a vázizomzat tömegének mennyiségét, ez alapján lehetséges megállapítanunk a sarcopenia, illetve a myopenia mértékét.…”

Section: Bevezetésunclassified

“…A myopenia akkor diagnosztizálható, ha az izomtömeg egy bizonyos küszöbérték alatt van. A PII értékének csökkenése összefüggésben van a műtét utáni szövődmények gyakoribb kialakulásával, a betegek elhúzódó felépülésével, az onkológiai kezelés hatékonyságának romlásával és a betegek hosszú távú túlélésének csökkenésével [11,18]. A CT vizsgálat segítségével megállapítható a vázizomzat sűrűségének értéke a psoas izom szintjén, Hounsfield egységekben (UH) kifejezve [7].…”

Section: Bevezetésunclassified

“…A sarcopenia viszonyított értéke férfiak és nők esetében különbözik, valamint eltérő lehet az értéke életkortól és emberi rassztól függően [11]. Egy meta-analízis szerint, amely a CR malignus daganatokkal rendelkező páciensek posztoperatív kimenetelét hasonlította össze sarcopenia jelenlétében vagy annak hiányában, arra a következtetésre jutott, hogy a sarcopenia fennállta összefügg a műtét utáni szövődmények kialakulásának magas kockázatával, valamint a posztoperatív súlyos szövődményekkel, továbbá a műtét utáni fertőzésekkel, cardiopulmonalis szövődményekkel, mortalitással és elhúzódó kórházi bennfekvéssel [38].…”

Section: Megbeszélésunclassified

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Preoperative psoas muscle index a modern prognostic factor in the follow-up of patients with rectal cancer who underwent surgery

Zoltán¹,

Linda

Alexandra³

et al. 2021

Bulletin of Medical Sciences

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Background: The incidence of rectum cancer is rising worldwide. New prognostic factors need to be applied to improve patients’ prognosis. The incidence of sarcopenia has been observed in various malignancies. The quantity of skeletal muscle mass is reflected in the psoas muscle index (PMI), suggesting the presence of sarcopenia. Our aim is to investigate the association of postoperative prognosis of patients with rectum cancer with the occurrence of preoperative sarcopenia with quantitative and qualitative reduction of skeletal muscle mass. Material and method: We performed a multidisciplinary research and we examined patients diagnosed with rectal cancer. The PMI was determined at the lower edge of the L3 vertebral body, using CT scan. We present our research partial results within three cases. Results: The PMI of three male patients with rectum cancer who received neoadjuvant chemoradiotherapy was: Case 1 has a PMI of 7.378 cm2/m2, the mean psoas muscle density was 50.14 UH. Case 2 has a PMI of 6,942 cm2/m2 and a mean psoas density of 43.81 UH. Case 3 has a PMI of 8.4885 cm2/m2 and an average density of 43.85 UH in the right and left psoas. Conclusions: The PMI value can be calculated with simple radiologic measurements, thus determining the diagnosis of sarcopenia. Calculations are performed using standard preoperative CT-scans. A PMI value above the threshold limit is promising in the short term, but in the long term it is not responsible for the deterioration of patients’ general condition and tumor recurrence.

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Preoperative sarcopenia negatively impacts short‐ and long‐term outcomes of rectal cancer: A propensity score‐matched analysis

Abe,

Nozawa,

Sasaki

et al. 2024

Annals of Gastroent Surgery

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AimSarcopenia is associated with poor postoperative outcomes in various cancers; however, limited evidence is available for rectal cancer. Therefore, the present study examined the effects of skeletal muscle mass on the short‐ and long‐term outcomes of rectal cancer.Materials and MethodsA total of 787 Stage I–IV rectal cancer patients who underwent curative resection between 2003 and 2021 at The University of Tokyo Hospital were included. We conducted a propensity score‐matched analysis to mitigate confounding bias. The third lumber psoas muscle mass was measured to define sarcopenia.ResultsAmong 787 patients, 350 (44.5%) were classified as having sarcopenia. After matching, 532 patients were analyzed. Patient characteristics in the sarcopenia and nonsarcopenia groups were similar; however, the body mass index differed. The sarcopenia group had significantly higher rates of postoperative complications of all grades (33.1% vs 24.8%; p = 0.035), of grade ≥2 (29.3% vs 21.8%; p = 0.047), and anastomotic leakage (1.9% vs 0%; p = 0.0082) than the nonsarcopenia group. The 5‐y overall survival rate was significantly lower in the sarcopenia group than in the nonsarcopenia group (85.3% vs 91.8%, p = 0.019). Disease‐free survival was similar between the groups (p = 0.40). In the total cohort analysis, sarcopenia was an independent risk factor for total postoperative complications (odds ratio 1.41, p = 0.042).ConclusionPreoperative sarcopenia is associated with more total postoperative complications, more anastomotic leakage, and worse survival in rectal cancer patients.

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Is radiological psoas muscle area measurement a predictor of postoperative complications after rectal resection for rectal cancer? A retrospective study

Cited by 14 publications

References 30 publications

The role of sarcopenia in fragility fractures of the pelvis – is sarcopenia an underestimated risk factor?

The role of sarcopenia in fragility fractures of the pelvis – is sarcopenia an underestimated risk factor?

Preoperative psoas muscle index a modern prognostic factor in the follow-up of patients with rectal cancer who underwent surgery

Preoperative sarcopenia negatively impacts short‐ and long‐term outcomes of rectal cancer: A propensity score‐matched analysis

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