Hanaoka Marie, Yasuno Masamichi, Ishiguro Megumi, Yamauchi Shinichi, Kikuchi Akifumi, Tokura Michiyo, Ishikawa Toshiaki, Nakatani Eiji, Uetake Hiroyuki
Department of Colorectal Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
Department of Chemotherapy and Oncosurgery, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan.
Int J Colorectal Dis. 2017 Jun;32(6):847-856. doi: 10.1007/s00384-017-2773-0. Epub 2017 Feb 11.
Sarcopenia is reported to be associated with complications after surgery. However, there is no established optimal parameter to determine sarcopenia affecting surgical outcome. This study investigated whether morphologic change of the psoas muscle (MPM) reflects sarcopenia and could be a predictor of complications after colorectal cancer surgery.
Colorectal cancer patients who underwent primary tumor resection with anastomosis between 2015 and 2016 were analyzed. MPM score was evaluated as the ratio of the short-to-long axis of the psoas muscle in CT images at the L3 vertebrae and classified into five MPM grades. Then, the impact of MPM grade on development of postoperative complications was investigated.
A total of 133 patients were studied. MPM score was significantly correlated to the sectional areas of the psoas muscle at the L3 vertebrae which was evaluated by manual tracing. 21.1% of the subjects were classified into severe MPM (defined as MPM grade 3-4). Overall and infectious complications were noted in 37 (27.8%) and 16 (12.0%) patients. Severe MPM (odds ratio [OR] 2.71, 95% confidence interval [CI] 1.09-6.73), longer operative time (OR 1.01, 95%CI 1.001-1.01), and open surgery (OR 2.73, 95%CI 1.17-6.35) were identified as independent risk factors of overall complications. Severe MPM (OR 4.26,95%CI 1.38-13.10) and open surgery (OR 3.42, 95%CI 1.11-10.48) were identified as independent factors associated with infectious complications.
MPM grade may be used as a simple and convenient marker of sarcopenia and to identify patients at increased risk of complications after colorectal cancer surgery.
据报道，肌肉减少症与术后并发症相关。然而，尚无确定影响手术结果的肌肉减少症的最佳参数。本研究调查了腰大肌形态学变化（MPM）是否反映肌肉减少症，以及能否作为结直肠癌手术后并发症的预测指标。
分析2015年至2016年接受原发性肿瘤切除并吻合术的结直肠癌患者。MPM评分通过L3椎体CT图像中腰大肌短轴与长轴之比进行评估，并分为五个MPM等级。然后，研究MPM等级对术后并发症发生的影响。
共研究了133例患者。MPM评分与通过手动追踪评估的L3椎体腰大肌横截面积显著相关。21.1%的受试者被归类为严重MPM（定义为MPM 3-4级）。37例（27.8%）和16例（12.0%）患者出现总体并发症和感染性并发症。严重MPM（比值比[OR]2.71，95%置信区间[CI]1.09-6.73）、手术时间延长（OR 1.01，95%CI 1.001-1.01）和开放手术（OR 2.73，95%CI 1.17-6.35）被确定为总体并发症的独立危险因素。严重MPM（OR 4.26，95%CI 1.38-13.10）和开放手术（OR 3.42，95%CI 1.11-10.48）被确定为与感染性并发症相关的独立因素。
MPM等级可作为肌肉减少症的简单便捷标志物，并用于识别结直肠癌手术后并发症风险增加的患者。
