Abstract

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.

Highlights

  • Colorectal cancer (CRC) is one of the most common cause of cancer related death

  • Sarcopenia identified by computer tomography (CT) scan as a gold standard for it, which is associated with impaired overall survival in gastrointestinal malignancies and postoperative morbidity, is more frequent in colorectal cancer patients in both non-metastatic and metastatic diseases [8]

  • This study aims to demonstrate the impact of the preoperative CT scan-based psoas muscle index (PMI) on postoperative complications defined by Clavien-Dindo classification following elective surgery for colorectal cancer

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Summary

Introduction

Colorectal cancer (CRC) is one of the most common cause of cancer related death. According to GLOBOCAN data it is the third most deadly and the fourth most commonly diagnosed malignant disease and it’s incidence has an increasing tendency [1,2]. Sarcopenia identified by computer tomography (CT) scan as a gold standard for it, which is associated with impaired overall survival in gastrointestinal malignancies and postoperative morbidity, is more frequent in colorectal cancer patients in both non-metastatic and metastatic diseases [8]. 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. 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. 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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