Is radiological psoas muscle area measurement a predictor of postoperative complications after rectal resection for rectal cancer? A retrospective study

Objective: This study aimed to investigate the effect of sarcopenia on the development of serious postoperative complications in patients who underwent curative pancreatectomy for pancreatic cancer. Methods: Total psoas index (TPI) was calculated for sarcopenia diagnosis by measures of psoas muscle area on the level of L3 spine from preoperative staging computerised tomograhpy (CT) images in pancreatic cancer patients undergoing curative resection. Patient demographics and postoperative outcomes were analised in sarcopenic and non-sarcopenic group. Results: It has been found to be statistically significant relation between severe postoperative complication and sarcopenia (p=0,001>). Sarcopenia was more associated with cardiac and pulmoner complications among others (p=0.007, p=0.003 respectively). In multivariate analysis, age (OR: 1,08. %95 CI: 1,01~1,15, p=0,013), ASA score (OR: 2,84. 95% CI 1,62 ~ 4,97. p= 0,043) and TPI (OR: 3,61. 95% CI: 1,58 ~ 5,74. p= 0,001>) has been found independent risk factors for severe postoperative complications. Conclusion: Our results suggest that sarcopenia determined by using TPI, which can be easily obtained by examining the preoperative CT imaging, is an independent risk factor of severe postoperative complications. Determining the degree of sarcopenia can affect patient selection, predictability of possible serious complications, elective operation preparation process with a combination of nutrition and exercise therapy in a particular patient group and decisions regarding adjuvant or neoadjuvant therapy.

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Sarcopenia is Associated with Perioperative Outcomes in Gastric Cancer Patients Undergoing Gastrectomy

Annals of Nutrition and Metabolism ◽

10.1159/000504283 ◽

2019 ◽

Vol 75 (4) ◽

pp. 213-222

Author(s):

Bo Shi ◽

Siyu Liu ◽

Junqiang Chen ◽

Jinlu Liu ◽

Yihuan Luo ◽

...

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Postoperative Complications ◽

Hospital Stay ◽

Univariate Analysis ◽

Psoas Muscle ◽

Perioperative Outcomes ◽

Muscle Area ◽

Skeletal Muscle Index ◽

Nutrition Risk

Background: Sarcopenia is a syndrome in which skeletal muscle reduction is the main manifestation of age-related and/or disease-related malnutrition associated with postoperative complications and mortality. Objectives: The aim of the current study was to investigate the association between sarcopenia and postoperative complications as well as the nutrition risk of patients with gastric cancer (GC) who received gastrectomy. In addition, a comparative analysis was performed to evaluate the diagnostic accuracy of total psoas muscle area (TPA) and skeletal muscle area (SMA) in sarcopenia. Methods: Preoperative computed tomography scans were obtained from 279 GC patients who received a gastrectomy from June 2011 to May 2016. TPA and SMA at the level of the third lumbar vertebra (L3) were used as the sarcopenia diagnostic index. Patients were diagnosed with sarcopenia via the total psoas muscle index (TPI) and skeletal muscle index (SMI) methods. TPI and SMI were normalized with the square of the patient’s height (m2) by TPA and SMA. The Clavien-Dindo complications score system was used to classify the complication extent after gastrectomy. Univariate and multivariate logistic regression analyses were carried out to evaluate the risk factors for postoperative complications. Results: A total of 68 and 125 patients were diagnosed with sarcopenia by TPI and SMI, respectively. Eighty-eight (31.5%) patients experienced postoperative complications. Patients with sarcopenia also had a significantly extended postoperative stay (TPI-sarcopenia, 15.0 days vs. non-sarcopenia, 11.0 days, p < 0.001; and SMI-sarcopenia, 14.0 days vs. non-sarcopenia, 11.0 days, p < 0.001) and hospital stay (TPI-sarcopenia, 22.5 days vs. non-sarcopenia, 17.0 days, p < 0.001; and SMI-sarcopenia, 21.0 days vs. non-sarcopenia, 16.5 days, p < 0.001). Multivariate logistic analysis showed that both TPI-sarcopenia (OR 7.561, p < 0.001) and SMI-sarcopenia (OR 10.085, p < 0.001) were associated with the risk of postoperative complications. Furthermore, univariate analysis showed a high correlation between nutrition risk screening 2002 (NRS2002) and sarcopenia (p < 0.001). A total of 54 (79.4%) of the 68 patients who were classified as having sarcopenia by TPI and 94 (75.3%) of the 125 patients who were classified as having sarcopenia by SMI were diagnosed with nutritional risk. Conclusions: Sarcopenia is associated with the total length of hospital stay, postoperative hospital stay, and severe complications in GC patients undergoing gastrectomy. Moreover, SMI may be a more meaningful index than TPI in reducing the rate of misdiagnosis and in predicting adverse perioperative risk. In addition, sarcopenia may cause severe malnutrition and increases perioperative adverse risk. Thus, both sarcopenia and the NRS2002 nutritional score should be assessed during preoperative nutritional screening and evaluation for GC patients.

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Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery

Medicina ◽

10.3390/medicina57050472 ◽

2021 ◽

Vol 57 (5) ◽

pp. 472

Author(s):

Zalán Benedek ◽

Szabolcs Todor-Boér ◽

Loránd Kocsis ◽

Orsolya Bauer ◽

Nicolae Suciu ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Psoas Muscle ◽

Albumin Level ◽

Cancer Surgery ◽

High Grade ◽

C Reactive Protein ◽

Muscle Area ◽

Colorectal Cancer Surgery ◽

Reactive Protein

Background and Objectives: Sarcopenia is a recognized prognostic factor for both complications and survival in cancer patients. This study aims to analyze the relationship between sarcopenia measured by psoas muscle index on computer tomography scans and the presence of postoperative complications in colorectal cancer surgery. Materials and Methods: In a prospective study we recorded data from 51 patients who underwent colorectal cancer surgery in the Mures County Clinical Hospital, Romania. Total psoas muscle area and psoas density were measured at the level of the third lumbal vertebra (L3) for further index calculation. We also evaluated the general characteristics and laboratory analyses to obtain more information about status of the patients. Short-term postoperative complications were scored according to the Clavien-Dindo classification. Results: The majority of the 51 patients were male (61%) and the median age was 65 years. More than half of the cancer was located in the rectum (56.9%), a quarter in the right colon (25.5%), the rest in the sigmoid (11.8%), and the left colon (5.9%). Twenty-one patients (41.2%) developed a complication, five (9.8%) of these were Clavien-Dindo grade 3, 4 or 5 (high grade) and sixteen (31.3%) grade 1 or 2 (low grade). The low- and high-grade groups showed a significantly lower right psoas muscle area, left psoas muscle area, total psoas muscle area, and psoas muscle index (p < 0.001 in all cases). Among laboratory analyses, a significantly lower perioperative hematocrit, hemoglobin, and albumin level were found in patients who developed complications. Furthermore we observed that an elevated serum C-reactive protein level was associated with a higher grade of complication (p < 0.043). Conclusions: The psoas muscle index (PMI) influence on the postoperative outcome is an important factor in our single center prospective study and it appears to be a good overall predictor in colorectal surgery. A lower PMI is directly associated with a low or high grade complication by Clavien-Dindo classification. Perioperative inflammatory and nutritional status evidenced by serum C-reactive protein (CRP) and albumin level influences the presence of postoperative complications.

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Age and comorbidities do not affect short-term outcomes after laparoscopic rectal cancer resection in elderly patients. A multi-institutional cohort study in 287 patients

Updates in Surgery ◽

10.1007/s13304-021-00990-z ◽

2021 ◽

Author(s):

Roberto Peltrini ◽

Nicola Imperatore ◽

Filippo Carannante ◽

Diego Cuccurullo ◽

Gabriella Teresa Capolupo ◽

...

Keyword(s):

Rectal Cancer ◽

Postoperative Complications ◽

Elderly Patients ◽

Rectal Resection ◽

Laparoscopic Approach ◽

Postoperative Outcomes ◽

Rectal Cancer Surgery ◽

Short Term ◽

Number Of Patients ◽

Laparoscopic Rectal Resection

AbstractPostoperative complications and mortality rates after rectal cancer surgery are higher in elderly than in non-elderly patients. The aim of this study is to evaluate whether, like in open surgery, age and comorbidities affect postoperative outcomes limiting the benefits of a laparoscopic approach. Between April 2011 and July 2020, data of 287 patients with rectal cancer submitted to laparoscopic rectal resection from different institutions were collected in an electronic database and were categorized into two groups: < 75 years and ≥ 75 years of age. Perioperative data and short-term outcomes were compared between these groups. Risk factors for postoperative complications were determined on multivariate analysis, including age groups and previous comorbidities as variables. Seventy-seven elderly patients had both higher ASA scores (p < 0.001) and cardiovascular disease rates (p = 0.02) compared with 210 non-elderly patients. There were no significative differences between groups in terms of overall postoperative complications (p = 0.3), number of patients with complications (p = 0.2), length of stay (p = 0.2) and death during hospitalization (p = 0.9). The only independent variables correlated with postoperative morbidity were male gender (OR 2.56; 95% CI 1.53–3.68, p < 0.01) and low-medium localization of the tumor (OR 2.12; 75% CI 1.43–4.21, p < 0.01). Although older people are more frail patients, short-term postoperative outcomes in patients ≥ 75 years of age were similar to those of younger patients after laparoscopic surgery for rectal cancer. Elderly patients benefit from laparoscopic rectal resection as well as non-elderly patient, despite advanced age and comorbidities.

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