Preoperative CT-Based Skeletal Muscle Mass Depletion and Outcomes after Total Laryngectomy

SIMPLE SUMMARY: Sarcopenia is characterized by the loss of skeletal muscle mass and function and is common in head and neck oncology. This retrospective study aimed to quantify preoperative muscle mass and quality using CT-based indices and to assess their impact on postoperative outcomes and survival in patients who underwent total laryngectomy for cancer. Based on pre-established cut-off values, 44% of the patients in this series had preoperative skeletal muscle mass depletion. No association was found between CT-based skeletal muscle mass depletion alone and postoperative outcomes or overall survival after total laryngectomy. ABSTRACT: Purpose: To assess the role of preoperative CT-based skeletal muscle mass depletion on postoperative clinical outcomes and survival in patients who underwent total laryngectomy for cancer. Methods: Patients operated on between January 2011 and March 2020 were retrospectively included. Skeletal muscle area and intra- and inter-muscular fat accumulation were measured at the third lumbar vertebral level on preoperative CT scans. Skeletal muscle mass depletion was defined based on pre-established cut-off values. Their association with postoperative morbidity, length of stay (LOS), costs, and survival was assessed. Results: A total of 84 patients were included, of which 37 (44%) had preoperative skeletal muscle mass depletion. The rate of postoperative fistula (23% vs. 35%, p = 0.348), cutaneous cervical dehiscence (17% vs. 11%, p = 0.629), superficial incisional surgical site infections (SSI) (12% vs. 10%, p = 1.000), and unplanned reoperation (38% vs. 37%, p = 1.000) were comparable between the two patient groups. No difference in median LOS was observed (41 vs. 33 days, p = 0.295), nor in treatment costs (119,976 vs. 109,402 CHF, p = 0.585). The median overall survival was comparable between the two groups (3.43 vs. 4.95 years, p = 0.09). Conclusions: Skeletal muscle mass depletion alone had no significant impact on postoperative clinical outcomes or survival.