Is Preoperative Sarcopenia a Good Predictor of Postoperative Complications and Outcomes after Pelvic Exenteration Surgery?

Abstract

Background: Sarcopenia is common in oncology patients and has been found to be associated with poorer outcomes after surgery. Pelvic exenteration is a major surgery associated with high rates of morbidity. The aim of this study was to determine if preoperative sarcopenia is associated with postoperative complications and outcomes after pelvic exenteration surgery. Methods: A retrospective study was conducted including 64 oncology patients who had undergone pelvic exenteration surgery between August 2015 and January 2018 and had available preoperative lumbar CT images. Skeletal muscle index (SMI) was calculated by analysing CT images using body composition software. Sarcopenia was determined by using previously published SMI sex-specific cut-offs. Preoperative nutritional status, nutritional indicators and other clinical factors were also collected. Results: There was no association between preoperative sarcopenia and outcomes after pelvic exenteration surgery, however, increased weight (p=0.027) and BMI (p=0.025) were associated with a greater number of total complications. Increasing age was also significant (p=0.001) in explaining the greater number of complications. Greater complexity of surgery itself was associated with greater postoperative complications (p=0.014) and increased length of hospital stay (p=0.001). Conclusion: Preoperative sarcopenia, using dichotomous cut-off points, is not sensitive enough to predict postoperative complications and outcomes in oncology patients undergoing pelvic exenteration surgery; however, other preoperative factors such as weight, BMI and age, and the complexity of surgery, do affect outcomes. Assessment tools that incorporate several clinical and physical factors, such as frailty assessments, should be used in future studies to identify risk factors in such major surgeries.