Abstract
The aim of this study was to evaluate whether body composition, muscle function, and their association are predictive factors for short-term postoperative complications in patients with gastric and colorectal cancer. A prospective cohort study was conducted with patients undergoing resection of gastric and colorectal tumors. Nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA) and anthropometric techniques. Low handgrip strength (HGS) was observed when <16kg for women, and <27kg for men. Computed tomography images were used to measure visceral adipose tissue, skeletal muscle index (SMI), and skeletal muscle radiodensity (SMD). Complications of grade II or above (according to Clavien-Dindo’s classification) were considered in a follow-up period of up to 30 days after surgery. Major complications were defined when they reached grade III or above. A total of 84 patients were analyzed (57.1% female, 59.7 ± 12.6 years) and 19% were diagnosed with low HGS + low SMI or SMD. Postoperative complications occurred in 51.2%, and these patients presented significantly longer duration of surgery and hospital stay. Major complications were observed in 16.7% of the total number of patients. Binary logistic regression adjusted by age, sex, and tumor staging showed that low SMD, low HGS + low SMI or SMD, and obesity were independent risk factors for postoperative complications, but only low SMD was an independent risk factor for major postoperative complications. Low SMD is an independent risk factor for short-term major complications following surgery in patients with gastric and colorectal cancer.
Highlights
Cancer is one of the leading causes of death worldwide, with an upward incidence due to population growth and aging, as well as the adoption of already proven carcinogenic habits such as smoking, inadequate diet, and physical inactivity [1, 2]
The median length of hospital stay was of 5 days (IQR: 4.0–8.7), and the time between Computed Tomography (CT) and the surgery was of 34 days (IQR: 23.2–48.7)
No statistically significant differences were found when comparing the prevalence of low skeletal muscle radiodensity (SMD) between patients with or without previous treatment (15% vs 17,2% respectively, p = 0.053) and tumor site (17.2% for gastric cancer vs 16.4% for colorectal cancer, p = 0.011)
Summary
Cancer is one of the leading causes of death worldwide, with an upward incidence due to population growth and aging, as well as the adoption of already proven carcinogenic habits such as smoking, inadequate diet, and physical inactivity [1, 2]. In Brazil, 625 thousand new cases are predicted to occur in each year in the 2020–2022 period, with gastric and colorectal tumors among the top 10 most occurring types [4]. Surgery is considered the cornerstone in the treatment of gastric and colorectal cancer, allowing staging of the disease, verifying its extension, and removing all visible tumors. Major surgeries are associated with a higher frequency of postoperative complications and greater morbidity, with a negative impact on short and long-term outcomes [5]. To prevent or minimize the occurrence of such complications, the impact of nutritional status, body composition, and functional capacity alterations in the pre-surgical period has been investigated [6,7,8]
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