Colorectal Surgical Unit, St Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 May;91(5):E292-E297. doi: 10.1111/ans.16706. Epub 2021 Mar 7.
Skeletal muscle depletion and subsequent functional loss is common in gastrointestinal malignancy. Usual markers of nutritional status may not be part of routine workup. The predictive value of sarcopenia was assessed and compared with clinically utilized factors. The aim of this was to assess the association between computed tomography assessed sarcopenia with outcomes in colorectal cancer resection.
A total of 228 consecutive patients who underwent curative colorectal cancer resection were included. Skeletal muscle area was measured at L3, with pre-defined gender-specific cut-offs applied to a height standardized index. Albumin, body mass index and Subjective Global Assessment scores were recorded alongside measures of comorbidity. Predictors of complications, mortality, and recurrence were identified through multivariate logistic regression.
Computed tomography assessed sarcopenia was significantly associated with longer stays, complications, 30-day mortality, readmissions and recurrence at 1 year. Specific associations with major, respiratory and cardiac complications were seen. It independently predicted overall complications (odds ratio 2.96, confidence interval 1.19-7.35 P = 0.019), recurrence at 1 year (odds ratio 8.00, confidence interval 1.45-44.21, P = 0.017) and an increase in comprehensive complication index of 14 (P = 0.002). Subgroup analysis found sarcopenia predicted overall complications in rectal surgery and major complications in colonic surgery. American Society of Anesthesiologists predicted complications but not major complications while cancer stage also predicted recurrence rates.
Sarcopenia presents an objective, available predictive factor that may be superior to current biochemical and clinical measures of nutritional and functional status. This study found it to be predictive of complication rates and recurrence after curative in colorectal cancer resection.
胃肠道恶性肿瘤常导致骨骼肌耗竭和随后的功能丧失。常用的营养状况标志物可能不是常规检查的一部分。本研究评估了肌少症的预测价值，并与临床常用因素进行了比较。目的是评估结直肠癌切除术后 CT 评估的肌少症与结局之间的关系。
共纳入 228 例接受根治性结直肠癌切除术的连续患者。在 L3 处测量骨骼肌面积，并应用预先确定的性别特异性截断值将身高标准化指数应用于该值。记录白蛋白、体重指数和主观整体评估评分以及合并症的指标。通过多变量逻辑回归确定并发症、死亡率和复发的预测因素。
CT 评估的肌少症与住院时间延长、并发症、30 天死亡率、再入院和 1 年复发显著相关。与主要、呼吸和心脏并发症有特定的相关性。它独立预测了总体并发症（优势比 2.96，95%置信区间 1.19-7.35，P=0.019）、1 年复发（优势比 8.00，95%置信区间 1.45-44.21，P=0.017）和综合并发症指数增加 14 分（P=0.002）。亚组分析发现肌少症预测直肠手术的总体并发症和结肠手术的主要并发症。美国麻醉医师学会预测了并发症，但不能预测主要并发症，而癌症分期也预测了复发率。
肌少症提供了一种客观、可用的预测因素，可能优于目前的生化和临床营养和功能状态评估方法。本研究发现肌少症与结直肠癌根治性切除术后的并发症发生率和复发相关。
