Abstract
Background: Sarcopenia is associated with poor postoperative outcomes in oncology patients. Computed tomography (CT) scans can be used to identify muscle wasting and sarcopenia. This study aimed to investigate if pelvic exenteration surgery leads to muscle wastage and thus, induction or exacerbation of sarcopenia. Methods: This is a retrospective review involving the analysis of CT scans before and after pelvic exenteration surgery to determine skeletal muscle index and diagnose sarcopenia. Other clinical and nutritional factors were collected. Results: A total of 34 patients met the inclusion criteria. Postoperative skeletal muscle index was significantly lower compared to preoperative skeletal muscle index (p=0.008). The incidence of sarcopenia was 62% preoperatively and rose to 74% postoperatively (p=0.073). Postoperative sarcopenia was not significantly associated with complications or mortality. Conclusion: The skeletal muscle index significantly decreased postoperatively, indicating that pelvic exenteration surgery leads to muscle wastage. The use of CT scans to recognise sarcopenia would allow focusing of resources for those at risk.
Highlights
Pelvic exenteration is a major surgical procedure for the treatment of advanced or recurrent cancer of the pelvis
This study aimed to investigate if pelvic exenteration surgery leads to muscle wastage and induction or exacerbation of sarcopenia
The skeletal muscle index significantly decreased postoperatively, indicating that pelvic exenteration surgery leads to muscle wastage
Summary
Pelvic exenteration is a major surgical procedure for the treatment of advanced or recurrent cancer of the pelvis It involves the en-bloc resection of the pelvic viscera, vessels, muscles, ligaments and part of the pelvic bone [1]. Despite the radical nature of the surgery and its associated high morbidity of approximately 70%, this surgery is being increasingly performed as it is the only potentially curative option for locally advanced and recurrent rectal cancer [2, 3] For those not receiving the surgery and being treated with radiotherapy alone, 5-year survival rates are as low as 3%, compared to a 5-year survival rate of 53% in those treated with pelvic exenteration surgery in an Australian quaternary hospital [3, 4]. Conclusion: The skeletal muscle index significantly decreased postoperatively, indicating that pelvic exenteration surgery leads to muscle wastage. The use of CT scans to recognise sarcopenia would allow focusing of resources for those at risk
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