School of Medicine, University of Glasgow, Glasgow, UK.
Department of Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK.
Tech Coloproctol. 2019 Sep;23(9):877-885. doi: 10.1007/s10151-019-02072-0. Epub 2019 Sep 5.
Colorectal cancer remains a common cause of cancer death in the UK, with surgery being the mainstay of treatment. An objective measurement of the suitability of each patient for surgery, and their risk-benefit calculation, would be of great utility. We postulate that sarcopenia (low muscle mass) could fulfil this role as a prognostic indicator. The aim of this study was to determine the relationship between sarcopenia and long-term outcomes in patients undergoing elective bowel resection for colorectal cancer.
One hundred and sixty-three consecutive patients who had elective curative colorectal resection for cancer were eligible for inclusion in the study. Psoas muscle mass was assessed on preoperative computed tomography scan at the level of the L3 vertebra and standardised for patient height (total psoas index, TPI). Sarcopenia (low muscle mass) was defined as < 524 mm/m in males and 385 mm/m in females. In addition to clinical-pathological parameters, postoperative complications were recorded and patients were followed up for mortality for 1 year after surgery.
Sarcopenia was present in 19.6% of the study participants and was significantly related to body mass index (p = 0.007), 30-day mortality (p = 0.042) and 1-year mortality (p = 0.046). In univariate analysis, American Society of Anesthesiologists grade (p = 0.016), tumour stage (p = 0.018) and sarcopenia (p = 0.043) were found to be significant independent predictors of 1-year mortality.
This study has found sarcopenia to be prevalent in patients with colorectal cancer having elective surgery. Independent of age, sarcopenia was associated with poorer 30-day mortality and survival at 1 year. Measurement of muscle mass preoperatively could be used to stratify a patient's risk, allowing targeted strategies such as prehabilitation, to be implemented to modify sarcopenia and improve long-term outcomes for patients.
结直肠癌仍然是英国常见的癌症死因，手术是主要的治疗方法。客观衡量每位患者是否适合手术以及风险效益计算将非常有用。我们推测肌肉减少症（肌肉量低）可以作为一种预后指标来发挥作用。本研究旨在确定肌肉减少症与接受择期结直肠切除术治疗结直肠癌患者的长期结局之间的关系。
本研究纳入了 163 例接受择期结直肠癌根治性切除术的连续患者。在 L3 椎体水平的术前 CT 扫描上评估腰大肌肌肉量，并按患者身高进行标准化（总腰大肌指数，TPI）。肌肉减少症（肌肉量低）定义为男性<524mm/m，女性<385mm/m。除临床病理参数外，还记录了术后并发症，并对患者进行了 1 年的术后死亡率随访。
研究参与者中肌肉减少症的发生率为 19.6%，与体重指数（p=0.007）、30 天死亡率（p=0.042）和 1 年死亡率（p=0.046）显著相关。在单因素分析中，美国麻醉医师协会分级（p=0.016）、肿瘤分期（p=0.018）和肌肉减少症（p=0.043）被发现是 1 年死亡率的独立显著预测因素。
本研究发现，择期手术的结直肠癌患者中肌肉减少症普遍存在。与年龄无关，肌肉减少症与 30 天死亡率和 1 年生存率较差相关。术前肌肉量的测量可用于分层患者的风险，从而实施针对性策略，如康复前治疗，以改变肌肉减少症并改善患者的长期结局。
