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Sarcopenia and major complications in patients undergoing oncologic colon surgery

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 outcom...

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Autores principales: Schneider, Michael, Hübner, Martin, Becce, Fabio, Koerfer, Joachim, Collinot, Jean‐Aibert, Demartines, Nicolas, Hahnloser, Dieter, Grass, Fabian, Martin, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718051/
https://www.ncbi.nlm.nih.gov/pubmed/34423589
http://dx.doi.org/10.1002/jcsm.12771
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author Schneider, Michael
Hübner, Martin
Becce, Fabio
Koerfer, Joachim
Collinot, Jean‐Aibert
Demartines, Nicolas
Hahnloser, Dieter
Grass, Fabian
Martin, David
author_facet Schneider, Michael
Hübner, Martin
Becce, Fabio
Koerfer, Joachim
Collinot, Jean‐Aibert
Demartines, Nicolas
Hahnloser, Dieter
Grass, Fabian
Martin, David
author_sort Schneider, Michael
collection PubMed
description 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/m(2) (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 cm(2), P = 0.974, and 43.4 vs. 44.3 cm(2)/m(2), 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.
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spelling pubmed-87180512022-01-06 Sarcopenia and major complications in patients undergoing oncologic colon surgery Schneider, Michael Hübner, Martin Becce, Fabio Koerfer, Joachim Collinot, Jean‐Aibert Demartines, Nicolas Hahnloser, Dieter Grass, Fabian Martin, David J Cachexia Sarcopenia Muscle Original Articles 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/m(2) (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 cm(2), P = 0.974, and 43.4 vs. 44.3 cm(2)/m(2), 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. John Wiley and Sons Inc. 2021-08-22 2021-12 /pmc/articles/PMC8718051/ /pubmed/34423589 http://dx.doi.org/10.1002/jcsm.12771 Text en © 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Schneider, Michael
Hübner, Martin
Becce, Fabio
Koerfer, Joachim
Collinot, Jean‐Aibert
Demartines, Nicolas
Hahnloser, Dieter
Grass, Fabian
Martin, David
Sarcopenia and major complications in patients undergoing oncologic colon surgery
title Sarcopenia and major complications in patients undergoing oncologic colon surgery
title_full Sarcopenia and major complications in patients undergoing oncologic colon surgery
title_fullStr Sarcopenia and major complications in patients undergoing oncologic colon surgery
title_full_unstemmed Sarcopenia and major complications in patients undergoing oncologic colon surgery
title_short Sarcopenia and major complications in patients undergoing oncologic colon surgery
title_sort sarcopenia and major complications in patients undergoing oncologic colon surgery
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718051/
https://www.ncbi.nlm.nih.gov/pubmed/34423589
http://dx.doi.org/10.1002/jcsm.12771
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