Abstract
BackgroundRadiologically defined sarcopenia has been shown to predict negative outcomes after cancer surgery, however radiological assessment of sarcopenia often requires additional software and standardisation against anthropomorphic data. Measuring psoas density using hospital Picture Archiving and Communication Systems (PACS), universally available in the UK, may have advantages over methods requiring the use of additional specialist and often costly software. The aim of this study was to assess the association between radiologically defined sarcopenia measured by psoas density and postoperative outcome in patients having a colorectal cancer resection.MethodsAll patients having a resection for colorectal cancer, discussed by the colorectal multi-disciplinary team in one institution between 1/1/15 and 31/12/15, were retrospectively identified. Mean psoas density at the level of the L3 vertebra was analysed from preoperative computed tomography (CT) scans to define sarcopenia using the Picture Archiving and Communication Systems (PACS). Postoperative complications and mortality were recorded.ResultsOne hundred and sixty-nine patients had a colorectal resection for cancer and 140 of these had a primary anastomosis. Ninety-day mortality and 1-year mortality were 1.1% and 7.1%, respectively. Eighteen (10.7%) patients suffered a Clavien–Dindo grade 3 or 4 complication of which 6 (33%) were anastomotic leaks. In the whole cohort, sarcopenia was associated with an increased risk of Clavien–Dindo grade 3 or 4 complications [adjusted OR 6.33 (1.65–24.23) p = 0.007]. In those who had an anastomosis, sarcopenia was associated with an increased risk of anastomotic leak [adjusted OR 14.37 (1.37–150.04) p = 0.026].ConclusionsA quick and easy radiological assessment of sarcopenia by measuring psoas density on preoperative CT scan using software universally available in the UK is highly predictive of postoperative morbidity in colorectal cancer patients.
Highlights
Sarcopenia, the age-related loss of muscle or lean mass is a marker of frailty which is associated with increased postoperative morbidity and mortality and can be identified at preoperative cross-sectional imaging [1,2,3]
Techniques in Coloproctology (2019) 23:129–134 patients most at risk of postoperative complications, individualising risk for improved preoperative counselling, identifying those who may benefit from prehabilitation interventions and perhaps influencing operative strategy such as whether to perform a primary anastomosis without a stoma [6, 7]
Most series have used either psoas area or other abdominal muscle cross-sectional areas to radiologically define sarcopenia and its effect on outcomes. These methods require standardisation for height, weight and sex and quantification of cross-sectional area needs to be performed on software packages separate from those used for the main viewing and clinical reporting of images, making these methods difficult to generalise [1]
Summary
Sarcopenia, the age-related loss of muscle or lean mass is a marker of frailty which is associated with increased postoperative morbidity and mortality and can be identified at preoperative cross-sectional imaging [1,2,3]. Measurement of muscle area at the third lumbar (L3) vertebral level on CT scan, suggests sarcopenia is associated with increased postoperative complications, 30-day and 90-day mortality, and reduced 1, 3 and 5 year survival [1]. The aim of this study was to assess the association between radiologically defined sarcopenia measured by psoas density and postoperative outcome in patients having a colorectal cancer resection. Conclusions A quick and easy radiological assessment of sarcopenia by measuring psoas density on preoperative CT scan using software universally available in the UK is highly predictive of postoperative morbidity in colorectal cancer patients
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