Sarcopenia and major complications in patients undergoing oncologic colon surgery

Abstract

Background Sarcopenia is a surrogate marker for malnutrition and frailty, which has been linked to higher complication rates and prolonged length of stay (LOS) after surgery. The study aim was to assess the correlation between computed tomography (CT)‐based sarcopenia and short‐term clinical outcomes after oncologic colon surgery. Methods This retrospective study included consecutive patients operated between May 2014 and December 2019. Three radiological indices of sarcopenia were measured at the level of the third lumbar vertebra on preoperative CT scans: skeletal muscle area (SMA), skeletal muscle index (SMI) (both markers of muscle quantity), and skeletal muscle radiation attenuation (SMRA) (marker of muscle quality). Patients with major complications (grade ≥ 3b according to the Clavien classification) were compared with those without. Statistical correlation between sarcopenia indices, LOS, and comprehensive complication index (CCI) was tested with the Pearson correlation coefficient. Results A total of 325 patients were included. Mean age was 67 years [standard deviation (SD) 14.3], mean body mass index was 26.0 kg/m2 (SD 5.3), and 193 (59%) were male. Fifty patients (15.4%) had major complications, while 275 (84.6%) did not. Patients with major complications had more open surgery (52 vs. 21%, P < 0.01), intraoperative blood loss (257 vs. 102 mL, P = 0.035), and intraoperative complications (22 vs. 9%, P = 0.012). Patients with major complications had significantly increased CCI scores (53 vs. 6, P < 0.01), reoperations (74 vs. 0%, P < 0.01), and LOS (33 vs. 7, P < 0.01). SMA and SMI were comparable between both groups (126.0 vs. 125.2 cm2, P = 0.974, and 43.4 vs. 44.3 cm2/m2, P = 0.636, respectively), while SMRA was significantly lower in patients with major complications (33.6 vs. 37.3 HU, P = 0.018). A lower SMRA was correlated with prolonged LOS (r = −0.207, P < 0.01) and higher CCI (r = −0.144, P < 0.01), while the other sarcopenia indices had no influence on surgical outcomes. Conclusions Muscle quality (SMRA) as a specific sarcopenia marker was lower in patients with major complications and seems to prevail over muscle quantity (SMA and SMI) in the prediction of adverse outcomes after oncologic colon surgery.

Association between CT-Based Preoperative Sarcopenia and Outcomes in Patients That Underwent Liver Resections

“…This could explain the fact that there was no difference in SMRA and IMAT between the two groups compared in this study. A hypothesis could be that the quantity and the quality of the muscle do not necessarily match, as already suggested by other studies [ 31 , 41 , 42 ]. These results contrasted with findings from a recent meta-analysis, where various CT-based sarcopenia indices were evaluated as predictors for the risk of major complications in patients undergoing hepato-pancreato-biliary surgery [ 43 ].…”

“…Other data acquisition and image reconstruction parameters varied slightly between patients, inherent to the study design and patient referral for liver surgery. Muscle mass and quality were measured on axial CT slices at the mid-pedicle level of the third lumbar vertebra using a semi-automated, deep-learning-based method with a U-Net architecture algorithm [ 29 , 30 , 31 ]. Similar methods have recently been validated on large data sets [ 32 , 33 ].…”

Simple Clinical Screening Underestimates Malnutrition in Surgical Patients with Inflammatory Bowel Disease—An ACS NSQIP Analysis

“…The present study confirms these findings, given the very low prevalence of about 4% when using this composite clinical screening tool, which may lead to the underdetection of patients at risk. The assessment of body composition through anthropometric measures may be more accurate and indispensable in this setting [ 18 , 19 ]. Furthermore, validated official nutritional screening tools such as the Nutritional Risk Score (NRS-2002), the Malnutrition Universal Screening Tool (MUST) or (GLIM) need to be considered, together with dedicated assessment by nutritional specialists [ 12 , 20 , 21 ].…”

Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction

“…These methods have been tested and validated on large CT datasets and are proven to be accurate and reliable. 28 , 29 All automated muscle segmentations were secondarily reviewed and corrected by an attending musculoskeletal radiologist (FB), blinded to the patient’s intervention (as the radiologist had at disposal the unique cross-sectional picture at the L3–L4 level extracted for each patient), using a custom free-hand image segmentation tool.…”