Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Eur J Surg Oncol. 2018 Sep;44(9):1354-1360. doi: 10.1016/j.ejso.2018.05.029. Epub 2018 Jun 6.
Preoperative low skeletal muscle mass and density are associated with increased postoperative morbidity in patients undergoing curative colorectal cancer (CRC) surgery. However, the long-term effects of low skeletal muscle mass and density remain uncertain.
Patients with stage I-III CRC undergoing surgery, enrolled in a prospective observational cohort study, were included. Skeletal muscle mass and density were measured on CT. Patients with high and low skeletal muscle mass and density were compared regarding postoperative complications, disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS).
In total, 816 patients (53.9% males, median age 70) were included; 50.4% had low skeletal muscle mass and 64.1% low density. The severe postoperative complication rate was significantly higher in patients with low versus high skeletal muscle and density (20.9% versus 13.6%, p = 0.006; 20.0% versus 11.8%, p = 0.003). Low skeletal muscle mass (OR 1.91, p = 0.018) and density (OR 1.87, p = 0.045) were independently associated with severe postoperative complications. Ninety-day mortality was higher in patients with low skeletal muscle mass and density compared with patients with high skeletal muscle mass and density (3.6% versus 1.7%, p = 0.091; 3.4% versus 1.0%, p = 0.038). No differences in DFS were observed. After adjustment for covariates such as age and comorbidity, univariate differences in OS and CSS diminished.
Low skeletal muscle mass and density are associated with short-term, but not long-term, outcome in patients undergoing CRC surgery. These findings recommend putting more emphasis on preoperative management of patients at risk for surgical complications, but do not support benefit for long-term outcome.
术前低骨骼肌量和密度与接受根治性结直肠癌（CRC）手术的患者术后发病率增加有关。然而，低骨骼肌量和密度的长期影响仍不确定。
纳入接受手术的 I-III 期 CRC 患者，进行前瞻性观察队列研究。在 CT 上测量骨骼肌量和密度。比较骨骼肌量和密度高与低的患者的术后并发症、无病生存率（DFS）、总生存率（OS）和癌症特异性生存率（CSS）。
共纳入 816 例患者（53.9%为男性，中位年龄 70 岁）；50.4%的患者骨骼肌量低，64.1%的患者骨骼肌密度低。与骨骼肌量和密度高的患者相比，骨骼肌量和密度低的患者严重术后并发症发生率显著更高（20.9%比 13.6%，p=0.006；20.0%比 11.8%，p=0.003）。低骨骼肌量（OR 1.91，p=0.018）和密度（OR 1.87，p=0.045）与严重术后并发症独立相关。与骨骼肌量和密度高的患者相比，骨骼肌量和密度低的患者 90 天死亡率更高（3.6%比 1.7%，p=0.091；3.4%比 1.0%，p=0.038）。DFS 无差异。在校正年龄和合并症等混杂因素后，OS 和 CSS 的单变量差异减小。
低骨骼肌量和密度与接受 CRC 手术患者的短期但非长期结局相关。这些发现表明，应更加重视有手术并发症风险的患者的术前管理，但不支持对长期结局有益。
