A new diagnostic index for sarcopenia and its association with short‐term postoperative complications in patients undergoing surgery for colorectal cancer
Abstract:Aim Sarcopenia is a robust prognostic indicator of outcomes after surgery for colorectal cancer (CRC). However, there are no serum markers routinely available for estimating skeletal muscle mass (SMM). The present study aimed to describe a new sarcopenia index (SI), serum creatinine (Scr) 9 cystatin C-based glomerular filtration rate, and investigate its association with shortterm complications after curative resection of CRC.Method Consecutive patients who underwent curative resection of CRC from December 201… Show more
“…After screening the abstracts and titles, 156 studies were scanned in full. After excluding the incompatible studies, a total of 70 studies were included in the systematic review [6, 13–15, 17, 18, 23–86]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Among the studies using SMI, three main criteria were the most commonly adopted criteria, including 47 studies. The cut-off of SMI introduced by Prado et al in 2008 (sarcopenia was defined as SMI < 52.4 cm 2 /m 2 for males and SMI < 38.5 cm 2 /m 2 for females) was used in 20 studies covering 10 countries [23, 30, 34, 35, 43–45, 47, 52, 57, 61, 62, 64, 67, 69, 73–76, 85]. The prevalence of sarcopenia ranged from 7.4 to 83.3% (7.4–71.8% in non-Asian countries, with a median prevalence of 40.1%; 14.6–83.3% in Asian countries, with a median prevalence of 52.7%).…”
Section: Resultsmentioning
confidence: 99%
“…The quality assessment is available in Table 2 and shows the study quality ranging from low to high quality, with scores ranging from 4 to 8 on the NOS scale. Eight studies were considered high quality, with a score of 8 [13, 18, 28, 54, 64, 72, 78, 79], fifty-three studies were considered moderate quality, with a score ranging from 5 to 7 [6, 15, 17, 23–27, 29, 30, 32–35, 37–41, 44–49, 51–53, 55–63, 65–71, 73–75, 80–85], and the remaining 9 studies were given a score of 4 and considered low quality [14, 31, 36, 42, 43, 50, 76, 77, 86]. According to the GRADE, the overall quality of the evidence of sarcopenia as a predictive factor for both long-term and short-term should be considered “very low” due to the lack of randomized control trials.…”
BackgroundThe impact of sarcopenia on the outcome of gastrointestinal (GI) oncological patients is still controversial. We aim to discuss the prevalence of sarcopenia and its relation to the oncological outcome.MethodsEmbase, Medline, PubMed, and the Cochrane library were systematically searched for related keywords. Studies using CT to assess sarcopenia and evaluate its relationship with the outcome of GI oncological patients were included. Long-term outcomes, including overall survival and disease-free survival, were compared by hazard ratios (HRs) with 95% confidence intervals (CIs). Short-term outcomes, including total complications and major complications (Clavien-Dindo ≥IIIa) after curable surgery, were compared by the risk ratio (RR) and 95% CI.ResultsA total of 70 studies including 21,875 patients were included in our study. The median incidence of sarcopenia was 34.7% (range from 2.1 to 83.3%). A total of 88.4% of studies used skeletal muscle index (SMI) in the third lumbar level on CT to define sarcopenia, and a total of 19 cut-offs were used to define sarcopenia. An increasing trend was found in the prevalence of sarcopenia when the cut-off of SMI increased (β = 0.22, 95% CI = 0.12–0.33, p < 0.001). The preoperative incidence of sarcopenia was associated both with an increased risk of overall mortality (HR = 1.602, 95% CI = 1.369–1.873, P < 0.001) and with disease-free mortality (HR = 1.461, 95% CI = 1.297–1.646, P < 0.001). Moreover, preoperative sarcopenia was a risk factor for both total complications (RR = 1.188, 95% CI = 1.083–1.303, P < 0.001) and major complications (RR = 1.228, 95% CI = 1.042–1.448, P = 0.014).ConclusionThe prevalence of sarcopenia depends mostly on the diagnostic cut-off points of different criteria. Preoperative sarcopenia is a risk factor for both long-term and short-term outcomes.
“…After screening the abstracts and titles, 156 studies were scanned in full. After excluding the incompatible studies, a total of 70 studies were included in the systematic review [6, 13–15, 17, 18, 23–86]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Among the studies using SMI, three main criteria were the most commonly adopted criteria, including 47 studies. The cut-off of SMI introduced by Prado et al in 2008 (sarcopenia was defined as SMI < 52.4 cm 2 /m 2 for males and SMI < 38.5 cm 2 /m 2 for females) was used in 20 studies covering 10 countries [23, 30, 34, 35, 43–45, 47, 52, 57, 61, 62, 64, 67, 69, 73–76, 85]. The prevalence of sarcopenia ranged from 7.4 to 83.3% (7.4–71.8% in non-Asian countries, with a median prevalence of 40.1%; 14.6–83.3% in Asian countries, with a median prevalence of 52.7%).…”
Section: Resultsmentioning
confidence: 99%
“…The quality assessment is available in Table 2 and shows the study quality ranging from low to high quality, with scores ranging from 4 to 8 on the NOS scale. Eight studies were considered high quality, with a score of 8 [13, 18, 28, 54, 64, 72, 78, 79], fifty-three studies were considered moderate quality, with a score ranging from 5 to 7 [6, 15, 17, 23–27, 29, 30, 32–35, 37–41, 44–49, 51–53, 55–63, 65–71, 73–75, 80–85], and the remaining 9 studies were given a score of 4 and considered low quality [14, 31, 36, 42, 43, 50, 76, 77, 86]. According to the GRADE, the overall quality of the evidence of sarcopenia as a predictive factor for both long-term and short-term should be considered “very low” due to the lack of randomized control trials.…”
BackgroundThe impact of sarcopenia on the outcome of gastrointestinal (GI) oncological patients is still controversial. We aim to discuss the prevalence of sarcopenia and its relation to the oncological outcome.MethodsEmbase, Medline, PubMed, and the Cochrane library were systematically searched for related keywords. Studies using CT to assess sarcopenia and evaluate its relationship with the outcome of GI oncological patients were included. Long-term outcomes, including overall survival and disease-free survival, were compared by hazard ratios (HRs) with 95% confidence intervals (CIs). Short-term outcomes, including total complications and major complications (Clavien-Dindo ≥IIIa) after curable surgery, were compared by the risk ratio (RR) and 95% CI.ResultsA total of 70 studies including 21,875 patients were included in our study. The median incidence of sarcopenia was 34.7% (range from 2.1 to 83.3%). A total of 88.4% of studies used skeletal muscle index (SMI) in the third lumbar level on CT to define sarcopenia, and a total of 19 cut-offs were used to define sarcopenia. An increasing trend was found in the prevalence of sarcopenia when the cut-off of SMI increased (β = 0.22, 95% CI = 0.12–0.33, p < 0.001). The preoperative incidence of sarcopenia was associated both with an increased risk of overall mortality (HR = 1.602, 95% CI = 1.369–1.873, P < 0.001) and with disease-free mortality (HR = 1.461, 95% CI = 1.297–1.646, P < 0.001). Moreover, preoperative sarcopenia was a risk factor for both total complications (RR = 1.188, 95% CI = 1.083–1.303, P < 0.001) and major complications (RR = 1.228, 95% CI = 1.042–1.448, P = 0.014).ConclusionThe prevalence of sarcopenia depends mostly on the diagnostic cut-off points of different criteria. Preoperative sarcopenia is a risk factor for both long-term and short-term outcomes.
“…based on disease site and stage). Furthermore, previous studies examining associations between CT-based measures of body composition and tumor site or survival estimates have only studied the colon as a whole, not left-and right colon separately [9,12,21,[26][27][28][29][30][31][32]. Tumor genetic and anthropomorphic features, as well as survival estimates, varies depending on right-or left-sided tumor localization.…”
Background: Cachexia and sarcopenia are associated with poor survival after colorectal cancer (CRC) diagnosis. Computed tomography (CT) can be used to measure aspects of cachexia including sarcopenia, myosteatosis and the amount of subcutaneous and visceral adipose tissue. The aim of this study was to relate CT-based body composition variables with survival outcomes in CRC. Material and methods: In this population-based, retrospective cohort study, CT scans of 974 patients with pathological stages I-IV CRCs, collected at or very near diagnosis (years 2000-2016), were used to measure cross-sectional fat and muscle tissue areas. Body composition variables based on these measurements were assessed in relation to tumor stage and site and cancer-specific survival in stages I-III CRC (n ¼ 728) using Cox proportional hazards models and Kaplan-Meier estimators. Results: Sarcopenia was associated with decreased cancer-specific survival, especially in patients with stages I-II tumors. The hazard ratio (HR) for the lowest versus highest tertile of skeletal muscle index (SMI) was 1.67; 95% confidence interval (CI), 1.08-2.58 for all stages, and HR 2.22; 95% CI 1.06-4.68, for stages I-II. Myosteatosis was also associated with decreased cancer-specific survival [(HR 2.03; 95% CI 1.20-3.34 for the lowest versus the highest tertile of skeletal muscle radiodensity (SMR)]. SMI and SMR were lower in patients with right-sided CRC, independent of age and sex. No adipose tissue measurement was significantly associated with cancer-specific survival. Conclusion: In concordance with previous studies, sarcopenia and myosteatosis were associated with decreased cancer-specific survival. The strong association between sarcopenia and poor cancer-specific survival in early-stage disease could have clinical implications for personalizing therapy decisions, including nutritional support.
“…Sarcopenia is of increasing clinical interest in a number of complex surgical specialties, including surgical oncology, transplant surgery, trauma, emergency, and vascular surgery [1][2][3][4][5][6][7][8][9][10]. Sarcopenia is defined as a loss of skeletal muscle mass, with an associated reduction in muscle strength and functional capacity [11][12][13]. Recent studies have identified sarcopenia as an independent predictor of poor postoperative outcomes following major abdominal surgery, particularly in patients undergoing oncological resection.…”
Background There is strong evidence suggesting that excessive fat distribution, for example, in the bowel mesentery or a reduction in lean body mass (sarcopenia) can influence short-, mid-, and long-term outcomes from patients undergoing various types of surgery. Body composition (BC) analysis aims to measure and quantify this into a parameter that can be used to assess patients being treated for abdominal wall hernia (AWH). This study aims to review the evidence linking quantification of BC with short-and long-term abdominal wall hernia repair outcomes. Methods A systematic review was performed according to the PRISMA guidelines. The literature search was performed on all studies that included BC analysis in patients undergoing treatment for AWH using Medline, Google Scholar and Cochrane databases by two independent reviewers. Outcomes of interest included short-term recovery, recurrence outcomes, and long-term data. Results 201 studies were identified, of which 4 met the inclusion criteria. None of the studies were randomized controlled trials and all were cohort studies. There was considerable variability in the landmark axial levels and skeletal muscle(s) chosen for analysis, alongside the methods of measuring the cross-sectional area and the parameters used to define sarcopenia. Only two studies identified an increased risk of postoperative complications associated with the presence of sarcopenia. This included an increased risk of hernia recurrence, postoperative ileus and prolonged hospitalisation. Conclusion There is some evidence to suggest that BC techniques could be used to help predict surgical outcomes and allow early optimisation in AWH patients. However, the lack of consistency in chosen methodology, combined with the outdated definitions of sarcopenia, makes drawing any conclusions difficult. Whether body composition modification can be used to improve outcomes remains to be determined.
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