Sarcopenia is associated with increased mortality but not complications following resection and reconstruction of sarcoma of the extremities

Abstract

Background and Objectives: Evidence regarding the impact of sarcopenia on operative outcomes in patients with sarcoma is lacking. We evaluated the relationship between sarcopenia and postoperative complications or mortality among patients undergoing tumor excision and reconstruction.Methods: We retrospectively reviewed 145 patients treated with tumor excision and limb reconstruction for sarcoma of the extremities. Sarcopenia was defined as psoas index (PI) < 5.45 cm 2 /m 2 for men and <3.85 cm 2 /m 2 for women from preoperative axial CT. Regression analyses were used to assess the association between postoperative complications or mortality with PI, age, gender, race, body mass index, tumor histology, grade, depth, location, size, and neoadjuvant/adjuvant therapy.Results: There were 101 soft tissue tumors and 44 primary bone tumors. Sarcopenia was present in 38 patients (26%). Sarcopenic patients were older (median age: 72 vs 59 years, P = .0010) and had larger tumors (86.5%, >5 cm vs 77.7%, P = .023).Seventy-three patients experienced complications (51%) and 18 patients died within 1 year. Sarcopenia and metastatic disease were associated with increased 12-month mortality (hazard ratio [HR] = 6.68, P < .001; HR: 8.51, P < .001, respectively) but not complications (HR 1.45, P = .155, odds ratio, 1.32, P = .426, respectively).Conclusions: Sarcopenia and metastatic disease were independently associated with postoperative mortality but no complications following surgery.

Opportunistic muscle measurements on staging chest CT for extremity and truncal soft tissue sarcoma are associated with survival

“…Despite recent findings by Hendrickson et al 12 that SMI is an independent predictor of 1‐year mortality in patients with sarcomas in the extremities, our results are consistent with previous results reported by Wilson et al where SMI was not a predictor of overall survival ( P = .746), after controlling for sex ( P = .712) in a Cox proportional hazard model 11 . Unlike Wilson et al 11 and our current study, Hendrickson et al 12 included both bone and soft tissue sarcomas in their analysis, which may result in greater heterogeneity in the cohort due to disease and treatment differences 12 . Unlike both prior studies that evaluated the psoas muscle on abdominal CTs at the L3 level, our study assessed the paravertebral muscle on chest CTs at the T12 level.…”

“…Wilson et al 11 assessed skeletal muscle mass using SMI at the L3 vertebral level. Recently, Hendrickson et al 12 similarly evaluated the association of SMI on mortality in both soft tissue and primary bone tumors. However, the CT protocols for staging of extremity STS often do not image at the L3 level used in those studies 7,10‐12 .…”

“…Recently, Hendrickson et al 12 similarly evaluated the association of SMI on mortality in both soft tissue and primary bone tumors. However, the CT protocols for staging of extremity STS often do not image at the L3 level used in those studies 7,10‐12 . Moreover, there is limited data on SMI and SMD on pelvis and abdomen CTs in patients with soft tissue sarcoma 13,14 .…”

Impact of preoperative sarcopenia in patients undergoing sacral tumor resection

“…As a surrogate for the quality of muscle, the psoas:lumbar vertebra index (PLVI) can be obtained on a CT scan 10 . In patients with malignancies, including sarcoma, sarcopenia has been found to be an independent predictor of complications and survival 11–20 . As part of the clinical staging and work‐up of patients undergoing sacral tumor resection, a CT scan of the pelvis is often obtained, 2 and therefore sarcopenia may be easily assessed in this cohort.…”

Comment on “The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction”

“…1 Sarcopenia has been extensively studied in patients undergoing oncologic procedures, however diagnostic approach in these trials has ongoing discussions. [2][3][4] So, we would like to address some methodological points in this manuscript. Tissue HU attenuation is easily affected by various factors, especially contrast-enhanced images.…”