Is Preoperative Sarcopenia a Good Predictor of Postoperative Complications and Outcomes after Pelvic Exenteration Surgery?

Abstract

Background: Sarcopenia is common in oncology patients and has been found to be associated with poorer outcomes after surgery. Pelvic exenteration is a major surgery associated with high rates of morbidity. The aim of this study was to determine if preoperative sarcopenia is associated with postoperative complications and outcomes after pelvic exenteration surgery. Methods: A retrospective study was conducted including 64 oncology patients who had undergone pelvic exenteration surgery between August 2015 and January 2018 and had available preoperative lumbar CT images. Skeletal muscle index (SMI) was calculated by analysing CT images using body composition software. Sarcopenia was determined by using previously published SMI sex-specific cut-offs. Preoperative nutritional status, nutritional indicators and other clinical factors were also collected. Results: There was no association between preoperative sarcopenia and outcomes after pelvic exenteration surgery, however, increased weight (p=0.027) and BMI (p=0.025) were associated with a greater number of total complications. Increasing age was also significant (p=0.001) in explaining the greater number of complications. Greater complexity of surgery itself was associated with greater postoperative complications (p=0.014) and increased length of hospital stay (p=0.001). Conclusion: Preoperative sarcopenia, using dichotomous cut-off points, is not sensitive enough to predict postoperative complications and outcomes in oncology patients undergoing pelvic exenteration surgery; however, other preoperative factors such as weight, BMI and age, and the complexity of surgery, do affect outcomes. Assessment tools that incorporate several clinical and physical factors, such as frailty assessments, should be used in future studies to identify risk factors in such major surgeries.

Is preoperative sarcopenia associated with postoperative complications after pelvic exenteration surgery?

“…The findings in this study are consistent with the conclusions of a smaller series of 64 patients, which evaluated the impact of sarcopenia on postoperative complications after PE surgery [ 15 ]. They concluded that preoperative sarcopenia measured radiologically was not sensitive enough to predict postoperative complications and outcomes in oncologic patients following PE surgery.…”

“…Given that malnutrition is one of the critical pathophysiological causes of sarcopenia, it is plausible that sarcopenia may also be a risk factor for major complications after PE surgery [ 14 ]. However, studies investigating the specific relationship between sarcopenia and postoperative complications after PE are scarce due to low patient numbers in a complex patient cohort [ 15 ]. This study aims to determine if preoperative sarcopenia is associated with postoperative complications after PE surgery.…”

Is the measurement of sarcopenia associated with oncological disease in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy?

“…For each individual CT image, body composition components were manually 'tagged' based on known Hounsfield Units (HU)skeletal muscle (À29 to 150), visceral adipose tissue (À150 to À50), intra-muscular adipose tissue (À190 to À30), and subcutaneous adipose tissue (À190 to À30). 9 To obtain a skeletal muscle index (SMI) (cm 2 /m 2 ), total cross-sectional area of skeletal muscle was normalized by height squared. Analysis of CT images was conducted by one trained investigator (AS), with a radiology registrar (MH) for anatomical uncertainties.…”

“…Calculated definitions of sarcopenia were determined from previously established sex-specific cut-offs -SMI <38.5 cm 2 /m 2 for women and < 52.4 cm 2 /m 2 for men. 9…”

“…The median PCI score (excluding PMP) was 11 [6][7][8][9][10][11][12][13][14][15][16][17][18] and the median PCI score (only PMP) was 25 (11-32) (Table 2). CC0 was achieved in the majority of patients excluding PMP (62 patients, 81.6%).…”