Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study

Abstract

Background Various body composition indices have been reported as prognostic factors for different cancers. However, whether body composition affects prognosis after lower gastrointestinal tract perforation requiring emergency surgery and multidisciplinary treatment has not been clarified. This study examined whether body composition evaluations that can be measured easily and quickly from computed tomography (CT) are useful for predicting prognosis. Methods Subjects comprised 64 patients diagnosed with perforation at final diagnosis after emergency surgery for a preoperative diagnosis of lower gastrointestinal tract perforation and penetration. They were divided into a survival group and a non-survival (in-hospital mortality) group and compared. Body composition indices (psoas muscle index (PMI); psoas muscle attenuation (PMA); subcutaneous adipose tissue index (SATI); visceral adipose tissue index (VATI); visceral-to-subcutaneous fat area ratio (VSR)) were measured from preoperative CT. Cross-sectional psoas muscle area at the level of the 3rd lumbar vertebra was quantified. Optimal cut-off values were calculated using receiver operating characteristic curve analysis. Poor prognostic factors were investigated from multivariate logistic regression analyses that included patient factors, perioperative factors, intraoperative factors, and body composition indices as explanatory variables. Results The cause of perforation was malignant disease in 12 cases (18.7%), and benign disease in 52 cases (81.2%). The most common cause was diverticulum of the large intestine. Emergency surgery for the 64 patients led to survival in 52 patients and death in 12 patients. On multivariate logistic regression analysis, independent predictors of poor prognosis were Sequential Organ Failure Assessment score (odds ratio 1.908; 95% confidence interval (CI) 1.235–3.681; P =0.0020) and PMI (odds ratio 13.478; 95%CI 1.342–332.690; P =0.0252). The cut-off PMI was 4.75 cm 2 /m 2 for males and 2.89 cm 2 /m 2 for females. Among survivors, duration of hospitalization was significantly longer in the low PMI group (29 days) than in the high PMI group (22 days, p=0.0257). Conclusions PMI is easily determined from CT and allows rapid evaluation of prognosis following lower gastrointestinal perforation.

S184: preoperative sarcopenia is associated with worse short-term outcomes following transanal total mesorectal excision (TaTME) for rectal cancer

“…Several studies have demonstrated the negative association between sarcopenia and postoperative outcomes in colorectal cancer patients [14,20,21,36,37], inflammatory bowel disease [38], pancreatic malignancy [27], and following hepatobiliary resection [28]. In a recent retrospective analysis of 350 patients undergoing colorectal cancer resection, Richards et al demonstrated that 32.9% of the cohort was classified as sarcopenic which was consistent with our cohort's sarcopenia rate of 34% [36].…”

Sarcopenia assessed by total psoas index – is it correlated with post-operative complications in all digestive cancers?

“…Kasahara et al proved that sarcopenia evaluated by the psoas muscle index was a predictor of overall survival in patients with advanced urothelial carcinoma undergoing chemotherapy [11]. In patients undergoing surgery for lower gastrointestinal perforation, the low psoas muscle index was a predictor of in-hospital mortality and prolonged hospitalization [12]. Using the cut-off for sarcopenia proposed by Hamaguchi et al [20], Nakayama and colleagues found the psoas muscle index to be a predictor of overall and event-free survival in patients with esophageal cancer undergoing neoadjuvant therapy [13].…”

“…[10], Kasahara et al [11], Kayano et al [12], Nakayama et al [13], Williet et al [14], Xu et al [15]) listed in table I.…”

“…Clear differentiation between muscles and surrounding tissue, completely visible muscle area without cuts, and lack of artifacts were the required criteria for the selected images to comply with quality indicators. Male patients (cm 2 /m 2 ) Cut-off 1 -Dodson et al [9] 3.38 4.77 Cut-off 2 -Jung et al [10] 4.43 8.18 Cut-off 3 -Kasahara et al [11] 2.07 2.49 Cut-off 4 -Kayano et al [12] 2.89 4.75 Cut-off 5 -Nakayama et al [13] 3.92 6.36 Cut-off 6 -Williet et al [14] 4.37 5.73 Cut-off 7 -Xu et al [15] 3.46 4.78…”