Impact of Sarcopenia on Postoperative Complications in Obstructive Colorectal Cancer Patients Who Received Stenting as a Bridge to Curative Surgery

Abstract

Objectives: Understanding the relationship between sarcopenia and malignancy is increasingly important since they inevitably affect the aging population. We investigated the clinical significance of sarcopenia in nonmetastatic obstructive colorectal cancer (OCRC) patients who were inserted self-expandable metallic stent and underwent curative surgery. Methods: Plain cross-sectional CT images obtained before stenting were retrospectively analyzed in 92 patients. Muscle volume loss (myopenia) and decreased muscle quality (myosteatosis) were evaluated as skeletal muscle index (SMI) and intramuscular adipose tissue content (IMAC), respectively. Results: This study included 54 men and 38 women, with a median age of 70.5 years. The median interval between SEMS placement and the surgery was 17 days (range, 5-47). There were 35 postoperative complications. The median postoperative hospital stay was 15.5 days (range, 8-77). Twenty-eight patients (41.3%) were classified as SMI-low, and 31 (34.1%) patients were classified as IMAC-high. In multivariate analysis, IMAC-high [hazard ratio (HR) = 7.68, 95% confidence interval (CI) 2.22-26.5, P = 0.001] and right-sided tumor (HR = 5.79, 95% CI 1.36-24.7, P = 0.018) were independent predictors of postoperative complications. IMAC-high (HR = 23.2, 95% CI 4.11-131, P < 0.001) and elevated modified Glasgow prognostic score (mGPS) (HR = 5.85, 95% CI 1.22-28.1, P = 0.027) were independent predictors of infectious complications. Relapse-free survival and overall survival were not significantly different regardless of the SMI or IMAC status. Conclusions: IMAC was associated with postoperative complications and infectious complications. Myosteatosis might be a stronger predictor of postoperative complications than myopenia.

High intramuscular adipose tissue content associated with prognosis and postoperative complications of cancers

“…After reviewing the abstracts and full text, 44 articles were further excluded. Finally, 24 articles published between 2015 and 2023 were included 12,14–19,22–38 …”

“…Finally, 24 articles published between 2015 and 2023 were included. 12,[14][15][16][17][18][19][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]…”

“…Many studies have found that IMAC is related to the prognosis of different cancers, such as hepatocellular carcinoma (HCC), gallbladder cancer (GBC), colorectal cancer (CBC) and gastric cancer (GC) 14–17 . However, a few studies suggest that IMAC does not reflect the survival outcome of cancer patients 18,19 . In light of the controversy, we conducted a meta‐analysis to determine whether IMAC could be used to evaluate survival outcomes and postoperative complications in cancer patients with sarcopenia.…”

Radiological Assessment of Sarcopenia and Its Clinical Impact in Patients with Hepatobiliary, Pancreatic, and Gastrointestinal Diseases: A Comprehensive Review

“…There is an association between sarcopenia with mortality, OS, recurrence-free survival, and postoperative complications. In this review, we found 13 studies 8 14 23 32 34 65 85 126 130 132 136 141 142 that reported on pancreatic and biliary malignancies and 31 studies 13 20 26 33 37 40 42 48 51 58 59 62 72 73 76 77 81 83 91 98 102 104 106 108 114 117 122 124 127 140 143 that reported on gastrointestinal and colorectal malignancies ( Tables 7 and 8 ).…”

Preoperative evaluation of sarcopenia in patients with colorectal cancer: a prospective study

“…Associations between sarcopenia and worse prognosis, such as high postoperative mortality, chemotherapy toxicity, reduced survival, higher infection rates, increased hospital length of stay, and increased mortality, have been pointed out recently [6][7][8][9][10][11][12][13] . Surgical resection in a patient with nonmetastatic colorectal cancer is an important aspect of cancer management, and including the evaluation of sarcopenia as a predictor of perioperative or postoperative morbidity risk can provide prognostic information for surgeons and patients.…”