The impact of sarcopenia on the outcome of patients with left-sided colon and rectal cancer after curative surgery

Abstract

Background The impact of sarcopenia on the outcome of patients with left-sided colon and rectal cancer has not been exhaustively investigated. Thus, the present study was performed to evaluate the effect of sarcopenia on the outcome of patients with left-sided colon and rectal cancer. Methods Patients with pathologically diagnosed stage I, II and III left-sided colon or rectal cancer who had undergone curative surgery between January 2008 and December 2014 were retrospectively reviewed. The psoas muscle index (PMI) identified by 3D-image analysis of computed tomographic images was the criterion used to diagnose sarcopenia. The cut-off value recommended by Hamaguchi (PMI value < 6.36 cm2/m2 for men and < 3.92 cm2/m2 for women) was adopted to confirm the diagnosis of sarcopenia. According to the PMI, each patient was divided into the sarcopenia group (SG) or the nonsarcopenia group (NSG). Then, the SG was compared with the NSG in terms of postoperative outcomes. Results Among the 939 patients included, 574 (61.1%) were confirmed to have preoperative sarcopenia. Initially, it was demonstrated that the SG was not significantly different from the NSG in terms of most baseline characteristics except for a lower body mass index (BMI) (P < 0.001), a larger tumour size (P < 0.001) and more weight loss (more than 3 kg in the last three months) (P = 0.033). The SG had a longer hospital stay after surgery (P = 0.040), more intraoperative blood transfusions (P = 0.035), and higher incidence of anastomotic fistula (P = 0.027), surgical site infection (SSI) (P = 0.037) and hypoalbuminemia (P = 0.022), 30-day mortality (P = 0.042) and 90-day mortality (P = 0.041). The SG had significantly worse overall survival (OS) (P = 0.016) and recurrence-free survival (RFS) (P = 0.036) than the NSG. Subsequently, Cox regression analysis revealed that preoperative sarcopenia was an independent predictive factor for worse OS (P = 0.0211, HR = 1.367, 95% CI: 1.049–1.782) and RFS (P = 0.045, HR = 1.299, 95% CI: 1.006–1.677). Conclusion Preoperative sarcopenia adversely affects the outcome of patients with left-sided colon and rectal cancer, and preoperative nutrition supplementation may help us improve their long-term and short-term outcomes.

Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates

“…Nutritional problems frequently exist in colorectal cancer patients, and this problem, which reaches the level of malnutrition in a significant part of them, adversely affects treatment and survival outcomes [ 1 , 5 , 6 ]. The importance of sarcopenia, one of the critical indicators of malnutrition, in patients undergoing colorectal surgery has attracted the attention of researchers, and in a recently published study evaluating 939 patients who underwent left colon and rectal surgery, 61% were found to have sarcopenia in the preoperative period [ 7 ]. Patients with sarcopenia necessitated more intraoperative transfusions, had lower albumin levels, and had prolonged hospital stays.…”

“…In addition, sarcopenia was found to have a negative impact on all survival parameters and mortality rates. More importantly, the Cox regression analysis revealed that preoperative sarcopenia was an independent predictive factor for worse OS [ 7 ].…”