Pędziwiatr M, Pisarska M, Major P, Grochowska A, Matłok M, Przęczek K, Stefura T, Budzyński A, Kłęk S
2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Kopernika 21, 31-501, Kraków, Poland.
2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Kopernika 21, 31-501, Kraków, Poland.
Eur J Surg Oncol. 2016 Jun;42(6):779-87. doi: 10.1016/j.ejso.2016.03.037. Epub 2016 Apr 19.
Progressive skeletal muscle loss (sarcopenia) is a negative prognostic factor in patients treated for colorectal cancer. Nevertheless, the clinical impact of those changes in body composition has been analyzed only in patients undergoing open resections. The aim of the study was to assess whether laparoscopy may eliminate the deleterious prognostic impact of sarcopenia and whether the combination with enhanced recovery after surgery (ERAS) protocol may improve postoperative recovery also in sarcopenic patients.
The study included 124 (73M/51F, mean age 65.9 years) patients undergoing elective laparoscopic colorectal resection for cancer. In all of them 16-item ERAS protocol was applied. The L3 skeletal muscle area identified on a preoperative CT scan was used to calculate skeletal muscle index and assess for sarcopenia and myosteatosis. The entire study group was divided into groups regarding the presence of sarcopenia or myosteatosis. The outcome measures were: length of hospital stay, complication rate and functional recovery parameters.
The prevalence of sarcopenia and myosteatosis was 27.4% and 38.7%, respectively. There was no association between the presence of sarcopenia or myosteatosis and postoperative complications. There were also no differences in the length of stay or readmission rates. Functional recovery (time to first flatus, oral diet tolerance and mobilization) was similar regardless of the presence of muscle depletion.
In contrary to traditional surgical approach, laparoscopy can reduce the negative impact of sarcopenia and myosteatosis on treatment results. ERAS protocol does not affect negatively the surgical outcomes in sarcopenic patients, compared to patients without changes in body skeletal mass.
进行性骨骼肌丢失（肌肉减少症）是接受结直肠癌治疗患者的不良预后因素。然而，仅在接受开放手术切除的患者中分析了这些身体成分变化的临床影响。本研究的目的是评估腹腔镜手术是否可以消除肌肉减少症的有害预后影响，以及与术后加速康复（ERAS）方案相结合是否也可以改善肌肉减少症患者的术后恢复情况。
本研究纳入了124例（73例男性/51例女性，平均年龄65.9岁）因癌症接受择期腹腔镜结直肠癌切除术的患者。所有患者均采用16项ERAS方案。术前CT扫描确定的L3骨骼肌面积用于计算骨骼肌指数，并评估肌肉减少症和肌少脂性。整个研究组根据是否存在肌肉减少症或肌少脂性进行分组。观察指标包括：住院时间、并发症发生率和功能恢复参数。
肌肉减少症和肌少脂性的患病率分别为27.4%和38.7%。肌肉减少症或肌少脂性的存在与术后并发症之间没有关联。住院时间或再入院率也没有差异。无论是否存在肌肉消耗，功能恢复（首次排气时间、口服饮食耐受性和活动能力）相似。
与传统手术方法相反，腹腔镜手术可以减少肌肉减少症和肌少脂性对治疗结果的负面影响。与身体骨骼肌质量无变化的患者相比，ERAS方案对肌肉减少症患者的手术结果没有负面影响。
