Association of Low Muscle Mass and Low Muscle Radiodensity With Morbidity and Mortality for Colon Cancer Surgery

Abstract

IMPORTANCE Given the risks of postoperative morbidity and its consequent economic burden and impairment to patients undergoing colon resection, evaluating risk factors associated with complications will allow risk stratification and the targeting of supportive interventions. Evaluation of muscle characteristics is an emerging area for improving preoperative risk stratification.OBJECTIVE To examine the associations of muscle characteristics with postoperative complications, length of hospital stay (LOS), readmission, and mortality in patients with colon cancer. DESIGN, SETTING, AND PARTICIPANTSThis population-based retrospective cohort study was conducted among 1630 patients who received a diagnosis of stage I to III colon cancer from January 2006 to December 2011 at Kaiser Permanente Northern California, an integrated health care system. Preliminary data analysis started in 2017. Because major complication data were collected between 2018 and 2019, the final analysis using the current cohort was conducted between 2019 and 2020.EXPOSURES Low skeletal muscle index (SMI) and/or low skeletal muscle radiodensity (SMD) levels were assessed using preoperative computerized tomography images. MAIN OUTCOMES AND MEASURESLength of stay, any complication (Ն1 predefined complications) or major complications (Clavien-Dindo classification score Ն3), 30-day mortality and readmission up to 30 days postdischarge, and overall mortality. RESULTSThe mean (SD) age at diagnosis was 64.0 (11.3) years and 906 (55.6%) were women. Patients with low SMI or low SMD were more likely to remain hospitalized 7 days or longer after surgery (odds ratio [OR], 1.33; 95% CI, 1.05-1.68; OR, 1.39; 95% CI, 1.05-1.84, respectively) and had higher risks of overall mortality (hazard ratio, 1.40; 95% CI, 1.13-1.74; hazard ratio, 1.44; 95% CI, 1.12-1.85, respectively). Additionally, patients with low SMI were more likely to have 1 or more postsurgical complications (OR, 1.31; 95% CI, 1.04-1.65) and had higher risk of 30-day mortality (OR, 4.85; 95% CI,. Low SMD was associated with higher odds of having major complications (OR, 2.41; 95% CI, 1.44-4.04).CONCLUSIONS AND RELEVANCE Low SMI and low SMD were associated with longer LOS, higher risk of postsurgical complications, and short-term and long-term mortality. Research should evaluate whether targeting potentially modifiable factors preoperatively, such as preserving muscle mass, could reverse the observed negative associations with postoperative outcomes.

The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis

“…Several factors may contribute to the discrepancy. Firstly, the present study noticed that gender has a significant impact on all body composition parameters evaluated, in line with previous reports [ 46 ]. Therefore, the cut-off level of each body composition parameter and the subsequent statistical analysis were gender dependent in the present study.…”

The Association of Body Composition Parameters and Laboratory Markers With The Severity of Hypertriglyceridemia-Induced Pancreatitis

“…Several factors may contribute to the discrepancy. Firstly, our study noticed that gender has a signi cant impact on all these body composition parameters, which has been reported before [35]. Therefore, the cut-off of each body composition parameter and the subsequent statistical analysis were gender dependent in our study.…”

Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: A cohort study

“…Several studies have evaluated body composition related to post-surgical complications in cancer patients. Recently, Xiao et al showed that both low SMI and low SMD were associated with a higher risk of postsurgical complications, and short-term and long-term mortality in patients with colorectal cancer [ 48 ]. In a similar population of the same nationality, using the same cut-off points for low SMI, Maurício et al [ 42 ] observed that low SMI and low muscle strength were associated with short-term postoperative complications in colorectal cancer patients.…”

“…SMD reflects the lipid content of the muscle, and SMI reflects the skeletal muscle volume or mass and it is measured as the skeletal muscle area divided by body height squared [ 51 ]. One possible explanation for this could be that the increase in lipid content of the muscle (myosteatosis) occurs before the decline in the size of muscle mass, and the deterioration of muscle is often occult, particularly in the presence of obesity [ 48 ]. Also, CT-based calculation allows for early detection of reduction in HU (SMD) while the muscle area remains unchanged; thus decrease in SMD is detected earlier than the corresponding decrease in SMI [ 52 ].…”