Preoperative evaluation of skeletal muscle mass in the risk assessment for the short‑term outcome of elderly colorectal cancer patients undergoing colectomy

Aoyama, Toru; Iguchi, Kenta; Fujikawa, Hirohito; Sawazaki, Sho; Sato, Tsutomu; Musiake, Hiroyuki; Oshima, Takashi; Yukawa, Norio; Rino, Yasushi; Masuda, Munetaka

doi:10.3892/mco.2018.1607

Cited by 9 publications

(6 citation statements)

References 23 publications

(19 reference statements)

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“…Our findings in patients with nonmetastatic colon cancer align with previous reports showing low SMI is consistently associated with a higher risk of complications. In contrast to the abundant sarcopenia literature, little is known regarding the consequences or etiology of low SMD in cancer.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 92%

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

et al. 2020

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“…1 The global estimates show that >18 million new cases of cancer were diagnosed in 2018 and accounted for >9 million deaths, with gastric and colorectal tumors among the top 10 in prevalence and mortality. 1,2 In patients with these types of cancer, malnutrition is prevalent [3][4][5] because of the combination of effects related to disease progression, host response to the tumor(s), treatment symptoms, and the direct effect of mechanical obstruction caused by the tumor, with consequent malabsorption of nutrients. 6,7 Knowledge about the negative impact of malnutrition on the prognosis of patients has led to the development of simple and effective tools for diagnosis and follow-up.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of isolated nutrition indicators in diagnosing malnutrition and their prognostic value to predict death in patients with gastric and colorectal cancer: A prospective study

Sousa

Silva²,

Carvalho

et al. 2021

J Parenter Enteral Nutr

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Background The study aims to evaluate the accuracy of isolated nutrition indicators in diagnosing malnutrition in patients with gastric and colorectal cancer and their association with mortality. Methods Prospective cohort study involving patients with cancer (n = 178) attending a reference center of oncology at any point in the disease trajectory or treatment. Nutrition status was evaluated in a unique moment by body mass index (BMI), Patient‐Generated Subjective Global Assessment (PG‐SGA), handgrip strength (HGS), and calf circumference (CC). Kappa coefficient, accuracy, sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) were calculated for each nutrition indicator (PG‐SGA as the reference method). The Cox proportional hazards model was used to assess hazard ratio (HR) and CI of mortality. Results From the total patients, 11% were underweight, 48% were malnourished (PG‐SGA B or C), 43% had low HGS, and 55% presented low CC. There were 46 deaths (25.8%). BMI, HGS, and CC showed poor and fair agreements (κ < 0.30 for all ) and poor accuracy (AUC < 0.70 for all) in identifying malnutrition by PG‐SGA. After the adjustment for confounders (age, treatment performed, site, and stage of cancer), PG‐SGA (HR, 2.9; 95% CI, 1.5–5.9) and low CC (HR, 2.4; 95% CI, 1.1–5.2) were independent predictors of mortality. Conclusion The nutrition indicators are not accurate in diagnosing malnutrition, whereas PG‐SGA and low CC could predict mortality in gastric and colorectal cancer patients. Thus, CC should be combined with PG‐SGA in nutrition assessments.

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“…It has been hypothesized that sarcopenia identi ed by CT could be used as a reliable but modi able factor for postoperative complications, deaths and cancer recurrence after curative surgery. By improving nutritional status of patients before surgery, we could signi cantly improve short-term [20] and long-term outcomes [21]. As known to us, left-sided colon cancer and rectal cancer are the most common among colorectal cancers.…”

Section: Discussionmentioning

confidence: 99%

The impacts of sarcopenia on outcomes of patients with left-sided colon or rectal cancer after curative surgery

et al. 2023

Preprint

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Background The impacts of nutritional status on and short-term and long-term survival of patients with left-sided colon or rectal cancer have not been exhaustively investigated. Thus, we accomplished the present study to evaluate the effects of sarcopenia on short-term and long-term outcomes of patients with left-sided colon or rectal cancer. Methods Patients with pathologically diagnosed stage I, II and III left-sided colon or rectal cancer who had undergone curative surgery were studied. The psoas muscle index (PMI) identified by 3D-image analysis of computed tomographic images was the criterion used to diagnose sarcopenia. The cutoff value recommended by Hamaguchi et al. (PMI value < 6.36 cm2/m2 for men and < 3.92 cm2/m2 for women) was adopted to confirm the diagnosis of sarcopenia. According to PMI, each patient was divided into the sarcopenia group (SG) or the non-sarcopenia group (NSG). Then SG was compared with NSG in terms of short-term outcomes and long-term outcomes. Results Among the 939 patients included, 574 ones (61.1%) were confirmed with preoperative sarcopenia. Initially, it was demonstrated that SG was not significantly different from NSG in terms of most baseline characteristics except smaller body mass index (BMI) (P < 0.001), larger tumor size (P < 0.001) and more weight loss (P = 0.029). Then it revealed that SG had a longer hospital stay after surgery (P = 0.040), more intraoperative blood transfusion (P = 0.035), and a higher incidence of anastomotic fistula (P = 0.027), incision infection (P = 0.037) and hypoalbuminemia (P = 0.022). The SG had significantly worse overall survival (OS) (P = 0.016) and recurrence-free survival (RFS) (P = 0.036) than the NSG. Subsequently, by Cox regression analysis, we revealed that preoperative sarcopenia was an independent predictive factor for worse OS (P = 0.0211, HR = 1.367, 95%CI: 1.049–1.782) and RFS (P = 0.045, HR = 1.299, 95%CI: 1.006–1.677). Conclusion Preoperative sarcopenia significantly adversely affected long-term and short-term outcomes of patients with left-sided colon or rectal cancer and preoperative nutrition supplementation may help us improve their long-term and short-term outcomes.

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Preoperative evaluation of skeletal muscle mass in the risk assessment for the short‑term outcome of elderly colorectal cancer patients undergoing colectomy

Cited by 9 publications

References 23 publications

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

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

Accuracy of isolated nutrition indicators in diagnosing malnutrition and their prognostic value to predict death in patients with gastric and colorectal cancer: A prospective study

The impacts of sarcopenia on outcomes of patients with left-sided colon or rectal cancer after curative surgery

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