Abstract
BackgroundPreoperative sarcopenia in older patients is a risk factor for adverse outcomes after colorectal cancer (CRC) surgery. Longitudinal changes in muscle mass in this group have not been studied previously although muscle wasting may have prognostic significance regarding survival. We aimed to determine the association between muscle wasting and overall survival (OS) in older patients who underwent surgery for CRC. MethodsPatients ≥70 years who underwent surgery for non-metastatic CRC in Gelre hospitals, The Netherlands, between 2011 and 2015 were included. Cross-sectional area of skeletal muscle was measured at the level of the 3rd lumbar vertebra on preoperative and postoperative abdominal CT-scans. Patients who had >1 standard deviation decrease in muscle mass were considered to have muscle wasting. Cox regression analysis was used to evaluate associations between muscle wasting and OS. Results233 patients were included (40% female, median age 76 years). Thirty-four patients had muscle wasting. After a median follow-up of 4.7 years, 53 (23%) patients died. The 3-year mortality rate was higher in patients with muscle wasting (27% vs 14%, p = .05). In multivariable analysis adjusted for age, recurrent disease and preoperative muscle mass, muscle wasting was associated with reduced OS (HR 2.8, 95% CI 1.5–5.4, p = .002). ConclusionMuscle wasting predicted poorer survival in older patients who underwent CRC surgery. Measuring changes in muscle mass may improve risk prediction in this patient group. Future studies should address the etiology of muscle wasting in older patients with CRC. Whether perioperative exercise interventions can prevent muscle wasting also warrants further study.
Highlights
An increasing number of older patients are undergoing surgery for colorectal cancer (CRC)
It is becoming increasingly clear that skeletal muscle depletion outperforms traditional markers of body composition such as body mass index (BMI) or weight loss when it comes to predicting mortality in patients with cancer [9,10]
After excluding patients based on the exclusion criteria, 233 patients remained in the study (Fig. 2)
Summary
An increasing number of older patients are undergoing surgery for colorectal cancer (CRC). While fast track surgery and minimally invasive techniques have been shown to reduce morbidity rates in older adults [1], many still experience life-threatening complications and decline in physical functioning This physical decline can lead to loss of independence and even mortality [2]. In the months and years following surgery, older patients are at risk for declining muscle mass due to age-related changes in muscle homeostasis, physical inactivity and nutritional deficiencies, and undergoing cancer treatment may further exacerbate this process [8]. We aimed to determine the association between muscle wasting and overall survival (OS) in older patients who underwent surgery for CRC. Conclusion: Muscle wasting predicted poorer survival in older patients who underwent CRC surgery. Whether perioperative exercise interventions can prevent muscle wasting warrants further study
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
