Abstract
BackgroundMuscle depletion is a poor prognostic indicator in colorectal cancer (CRC) patients, but there were no data assessing comparative temporal body composition changes following elective CRC surgery. We examined patient skeletal muscle index trajectories over time after surgery and determined factors that may contribute to those alterations.Methods Patients diagnosed with CRC undergoing elective surgical resection between 2006 and 2013 were included in this study. Image analysis of serial computed tomography (CT) scans was used to calculate lumbar skeletal muscle index (LSMI). A multilevel mixed-effect linear regression model was applied using STATA (version 12.0) using the xtmixed command to fit growth curve models (GCM) for LSMI and time.ResultsIn 856 patients, a total of 2136 CT images were analyzed; 856 (38.2 %) were preoperative. A quadratic GCM with random intercept and random slope for patients’ LSMI was identified that demonstrated laparoscopy produces a positive change on the LSMI curve [estimate = 0.17 cm2/m2, standard error (SE) 0.06 cm2/m2; p = 0.03], whereas Union for International Cancer Control (UICC) stage III + IV disease contributed to a negative curve change (estimate = −0.19 cm2/m2, SE 0.09 cm2/m2; p = 0.03). Older age (p < 0.01), female gender (p < 0.01), higher American Society of Anesthesiologists (ASA) score (p < 0.01), and altered systemic inflammatory response [SIR] (p = 0.03) were factors significantly associated with lower values of LSMI over time.ConclusionIn patients undergoing CRC surgery, laparoscopy and the absence of a significantly elevated SIR favored preservation and restoration of skeletal muscle, postoperatively. These emerging data may permit the development of new treatment protocols whereby monitoring and modification of body composition has therapeutic potential.
Highlights
Muscle depletion is a poor prognostic indicator in colorectal cancer (CRC) patients, but there were no data assessing comparative temporal body composition changes following elective CRC surgery
The majority of the operations were performed or supervised by one of two consultant colorectal surgeons (RHK and JTJ) who were designated CRC surgeons and were both trained in laparoscopic colorectal surgery, with the laparoscopic technique being standardized between surgeons
NLR neutrophil to lymphocyte ratio, ASA American Society of Anesthesiologists physical status, UICC Union for International Cancer Control, BMI body mass index surgeons performed both open and laparoscopic colorectal resections
Summary
Muscle depletion is a poor prognostic indicator in colorectal cancer (CRC) patients, but there were no data assessing comparative temporal body composition changes following elective CRC surgery. We examined patient skeletal muscle index trajectories over time after surgery and determined factors that may contribute to those alterations. Image analysis of serial computed tomography (CT) scans was used to calculate lumbar skeletal muscle index (LSMI). A multilevel mixed-effect linear regression model was applied using STATA (version 12.0) using the xtmixed command to fit growth curve models (GCM) for LSMI and time. A quadratic GCM with random intercept and random slope for patients’ LSMI was identified that demonstrated laparoscopy produces a positive change on the LSMI curve [estimate = 0.17 cm2/m2, standard error (SE) 0.06 cm2/ m2; p = 0.03], whereas Union for International Cancer Control (UICC) stage III ? Older age (p \ 0.01), female gender (p \ 0.01), higher American Society of Anesthesiologists (ASA) score (p \ 0.01), and altered systemic
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