School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Surgery, San Gerardo Hospital, Monza, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Radiology, San Gerardo Hospital, Monza, Italy.
Nutrition. 2020 Jul-Aug;75-76:110779. doi: 10.1016/j.nut.2020.110779. Epub 2020 Mar 5.
Baseline body composition has been associated with dismal outcomes in patients undergoing a variety of major abdominal operations. Whether specific anthropometric indexes can predict morbidity after rectal resection has been poorly investigated. The aims of this study were to assess whether there is a relationship between body mass index and the different computed tomography-assessed body composition indexes, and whether the analysis of different body compartments could be predictive of short-term outcomes in patients undergoing curative surgery for rectal cancer.
Computed tomography-derived measures of skeletal muscle and adipose tissue areas of patients undergoing surgery for rectal cancer between January 2009 and December 2016 were used to calculate population-specific thresholds of sarcopenia, subcutaneous adiposity, visceral adiposity, visceral obesity, sarcopenic obesity, and myosteatosis. Association between the aforementioned body composition features were related with overall complication, infection, and anastomotic leak.
During the study period, 311 patients received surgery and 173 were eligible for an accessible preoperative computed tomography imaging. After surgery, 59 (34.1%) patients experienced a complication, 29 an infection, and 10 an anastomotic failure. The overall morbidity rate was observed more frequently in patients with sarcopenia than in those without sarcopenia (39% versus 17.5%; P = 0.002) and infections (41.4% versus 21.5% respectively; P = 0.024). The presence of myosteatosis also was associated with a higher incidence of overall morbidity (33.9% versus 20.2% in patients without myoteatosis; P = 0.048). Anastomotic failure occurred in 6 of 10 patients with visceral obesity and in 24 of 112 (21.4%) patients without this condition (P = 0.007).
Some anthropometric indexes are accurate predictors of specific types of morbidity. These findings may allow a more accurate preoperative risk stratification.
基线身体成分与接受各种主要腹部手术的患者的不良结局相关。特定的人体测量指标是否可以预测直肠切除术后的发病率尚未得到充分研究。本研究的目的是评估体重指数与不同 CT 评估的身体成分指标之间是否存在关系，以及不同身体部位的分析是否可以预测接受直肠癌根治性手术的患者的短期结局。
使用 2009 年 1 月至 2016 年 12 月接受直肠癌手术患者的计算机断层扫描（CT）衍生的骨骼肌和脂肪组织面积来计算特定人群的肌少症、皮下脂肪过多、内脏脂肪过多、内脏肥胖、肌少症合并肥胖症和肌内脂肪过多的阈值。将上述身体成分特征与总体并发症、感染和吻合口漏进行关联。
在研究期间，311 例患者接受了手术，其中 173 例患者术前 CT 图像可获取。手术后，59 例（34.1%）患者发生并发症，29 例感染，10 例吻合口失败。与非肌少症患者相比，肌少症患者的总体发病率更高（39%比 17.5%；P=0.002），感染率也更高（41.4%比 21.5%；P=0.024）。肌内脂肪过多的存在也与总体发病率升高相关（无肌内脂肪过多的患者为 33.9%，无肌内脂肪过多的患者为 20.2%；P=0.048）。10 例内脏肥胖患者中发生吻合口失败 6 例，112 例无内脏肥胖患者中发生吻合口失败 24 例（21.4%）（P=0.007）。
一些人体测量指标是特定类型发病率的准确预测指标。这些发现可能允许更准确的术前风险分层。
