van der Kroft G, Bours Dr M J L, Janssen-Heijnen Dr M, van Berlo Dr C L H, Konsten Dr J L M
Department of General, Gastrointestinal and Transplant Surgery, Uniklinik Aachen, Aachen, Germany.
Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
Clin Nutr ESPEN. 2018 Apr;24:114-119. doi: 10.1016/j.clnesp.2018.01.003. Epub 2018 Mar 2.
Computed tomography (CT) can be used for accurate estimation of whole-body muscle mass and muscle density and for detection of sarcopenia. The goal of this study was to evaluate the additional value of CT measured sarcopenia and muscle attenuation alongside the Malnutrition Universal Screening Tool (MUST) for the prediction of post-operative morbidity after oncological colorectal resection, whilst correcting for known risk factors.
A prospective cohort study of 80 patients undergoing elective colorectal surgery in the Netherlands. Patients were screened for nutritional risk upon admission using the MUST. Additionally, preoperative CT scans were used to determine skeletal muscle mass for the detection of sarcopenia and muscle attenuation. Univariate and multivariable analyses were performed to evaluate associations between the MUST, muscle attenuation and sarcopenia on the one hand and post-operative complications measured by the Clavien-Dindo score on the other hand.
American Society of Anesthesiology-classification (ASA) ≥3, age ≥70, MUST ≥2 and lower than median muscle attenuation were significantly associated with a higher risk for postoperative complications (Clavien-Dindo score ≥2) (p ≤ 0.05), whereas sarcopenia was not (p = 0.59). Multivariate analyses showed that only MUST ≥2 remained significantly associated with postoperative complications when corrected for age (p = 0.03, OR 5.8, 95%CI 1.1-29.6), but not when corrected for age ≥70 and ASA ≥3. Muscle attenuation and sarcopenia were not significantly associated with postoperative complications.
Our results suggest that using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery. It also underlines the importance of currently implemented easy-to-use nutritional screening tools (MUST) and raises the question of the evaluation of muscle quality versus quantity in body composition imaging. However, further research is needed to investigate the role of sarcopenia for predicting outcome after colorectal surgery, and investigate the role of muscle attenuation measurements for the prediction of muscle function. CATEGORY OF SUBMISSION: observational study.
计算机断层扫描（CT）可用于准确估计全身肌肉质量和肌肉密度，并用于检测肌肉减少症。本研究的目的是评估CT测量的肌肉减少症和肌肉衰减值在营养不良通用筛查工具（MUST）之外，对肿瘤性结直肠切除术后手术并发症预测的附加价值，同时校正已知的风险因素。
对荷兰80例行择期结直肠手术的患者进行前瞻性队列研究。患者入院时使用MUST进行营养风险筛查。此外，术前CT扫描用于确定骨骼肌质量以检测肌肉减少症和肌肉衰减。进行单变量和多变量分析，以评估MUST、肌肉衰减和肌肉减少症一方面与用Clavien-Dindo评分衡量的术后并发症另一方面之间的关联。
美国麻醉医师协会分级（ASA）≥3、年龄≥70岁、MUST≥2以及低于肌肉衰减中位数与术后并发症（Clavien-Dindo评分≥2）风险较高显著相关（p≤0.05），而肌肉减少症并非如此（p = 0.59）。多变量分析显示，校正年龄后，只有MUST≥2仍与术后并发症显著相关（p = 0.03，OR 5.8，95%CI 1.1 - 29.6），但校正年龄≥70岁和ASA≥3后则不然。肌肉衰减和肌肉减少症与术后并发症无显著关联。
我们的结果表明，对于预测肿瘤性结直肠手术后短期术后发病率增加，使用CT测量的肌肉减少症相对于MUST可能只有很小的附加价值。这也强调了当前实施的易于使用的营养筛查工具（MUST）的重要性，并引发了在身体成分成像中评估肌肉质量与数量的问题。然而，需要进一步研究来调查肌肉减少症在预测结直肠手术后结局中的作用，以及研究肌肉衰减测量在预测肌肉功能中的作用。提交类别：观察性研究。
