Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery

Abstract

Background and Objectives: Sarcopenia is a recognized prognostic factor for both complications and survival in cancer patients. This study aims to analyze the relationship between sarcopenia measured by psoas muscle index on computer tomography scans and the presence of postoperative complications in colorectal cancer surgery. Materials and Methods: In a prospective study we recorded data from 51 patients who underwent colorectal cancer surgery in the Mures County Clinical Hospital, Romania. Total psoas muscle area and psoas density were measured at the level of the third lumbal vertebra (L3) for further index calculation. We also evaluated the general characteristics and laboratory analyses to obtain more information about status of the patients. Short-term postoperative complications were scored according to the Clavien-Dindo classification. Results: The majority of the 51 patients were male (61%) and the median age was 65 years. More than half of the cancer was located in the rectum (56.9%), a quarter in the right colon (25.5%), the rest in the sigmoid (11.8%), and the left colon (5.9%). Twenty-one patients (41.2%) developed a complication, five (9.8%) of these were Clavien-Dindo grade 3, 4 or 5 (high grade) and sixteen (31.3%) grade 1 or 2 (low grade). The low- and high-grade groups showed a significantly lower right psoas muscle area, left psoas muscle area, total psoas muscle area, and psoas muscle index (p < 0.001 in all cases). Among laboratory analyses, a significantly lower perioperative hematocrit, hemoglobin, and albumin level were found in patients who developed complications. Furthermore we observed that an elevated serum C-reactive protein level was associated with a higher grade of complication (p < 0.043). Conclusions: The psoas muscle index (PMI) influence on the postoperative outcome is an important factor in our single center prospective study and it appears to be a good overall predictor in colorectal surgery. A lower PMI is directly associated with a low or high grade complication by Clavien-Dindo classification. Perioperative inflammatory and nutritional status evidenced by serum C-reactive protein (CRP) and albumin level influences the presence of postoperative complications.

The psoas muscle density as a predictor of postoperative complications in elderly patients undergoing rectal cancer resection

“…Chai et al [10] revealed that sarcopenia de ned by TAMA was signi cantly associated with complications. Benedek et al [11] discovered that TPA was related to postoperative complications instead of PMD, consistent with Wu et al [9]. However, Pekařová et al [12] and Cuijpers et al [13] unveiled that PMD was correlated with postoperative complications rather than TPA.…”

Sarcopenia assessed by total psoas index – is it correlated with post-operative complications in all digestive cancers?

“…A meta-analysis focused on patients undergoing esophageal cancer surgery found no correlation between sarcopenia and the rate of postoperative complications [8]. Recently, Benedek et al correlated the psoas muscle index as a continuous variable to the severity of postoperative complications in patients with colorectal cancer [19]. When examining the psoas index as a dichotomous variable, using distinct cut-off values, various authors proposed cut-off values linked to specific outcomes in diverse clinical settings.…”

Primary Tumor Fluorine‐18 Fluorodeoxydglucose (18F‐FDG) Is Associated With Cancer-Associated Weight Loss in Non-Small Cell Lung Cancer (NSCLC) and Portends Worse Survival

“…Regarding sarcopenia, this would have entailed comprehensive evaluations of skeletal muscle mass and function. Although CT imaging permits an estimation of total body skeletal muscle mass through visualization of major muscle groups, we lacked longitudinal imaging data for comparison (40)(41)(42)(43). Furthermore, muscle function tests such as grip strength were not routinely obtained for this cohort.…”