Evaluation of Sarcopenia in Older Patients Undergoing Head and Neck Cancer Surgery

Abstract

Objectives/Hypothesis: Sarcopenia is a hallmark of aging and its identification may help predict adverse postoperative events in patients undergoing head and neck surgery. The study objective was to assess the relationship between sarcopenia and postoperative complications and length of stay in patients undergoing major head and neck cancer surgery.Study Design: Prospective cohort study.Methods: A prospective cohort study was performed of patients 50 years and older undergoing major head and neck surgery. Sarcopenia was defined as low muscle mass (determined by neck muscle cross-sectional imaging) with either low muscle strength (grip strength) or low muscle performance (timed walk test). Logistic regression was applied on binary outcomes, and linear regression was used for log-transformed length of hospital stay (LOS). Univariate and multivariate analyses were performed.Results: Of the 251 patients enrolled, pre-sarcopenia was present in 34.9% (n = 87) and sarcopenia in 15.6% (n = 39) of patients. Patients with sarcopenia were more likely to be older (P = .001), female (P = .001), have a lower body mass index (P = .001), and lower preoperative hemoglobin (P < .001). On univariate analysis, the presence and severity of sarcopenia was associated with the development of medical complications (P = .029), higher grade of complications (P = .032), LOS (P = .015), and overall survival (P = .001). On multivariate analysis, sarcopenia was associated with a longer LOS (β = 0.32 [95% CI: 0.19-0.45], P < .001) and worse overall survival (HR = 2.21 [95% CI: 1.01-4.23], P = .017).Conclusions: Sarcopenia may aid in the prediction of prolonged hospital stay and death in patients who are candidates for major head and neck surgery.

Sarcopenia and its impact in head and neck cancer treatment

“…Sarcopenia was associated with an increased risk of grade 3 or higher complications (OR 5.42; 95% CI 1.51–19.42), whereas presarcopenia was not. Sarcopenia was an independent predictor of increased length of hospital stay [46 ▪ ]. Comparable results were also found by Alwani et al in 168 patients receiving free flap reconstruction after resection for HNC.…”

Enhanced recovery after surgery, current, and future considerations in head and neck cancer

“…Sarcopenia is associated with worse OS and disease‐free survival in HNC 117–121 . Evaluation of sarcopenia should be done during the first clinic visit with a validated screening tool such as hand grip strength or chair rise test 105,122,123 . Early detection and intervention on sarcopenia may improve patient outcomes 124 .…”

Appendicular anthropometric changes and poor ECOG performance status is associated with sarcopenia in individuals with Head and neck squamous cell carcinoma.

“…Notably, in most studies of individuals with HNSCC, the diagnosis of sarcopenia was established exclusively using low SMM as criteria [71,72]. Only a few studies have used the combination of muscle function and skeletal muscle mass for the de nition of sarcopenia in individuals with HNSCC [31,73].…”