Pekařová Anna, Pekař Matej, Soltes Marek, Havrlentová Lucia, Chovancová Tereza
Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Lung Disease Department, Faculty Hospital, Ostrava, Czech Republic.
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):91-97. doi: 10.5114/wiitm.2020.100880. Epub 2020 Nov 13.
Sarcopaenia seems to be predictive factor for postoperative morbidity and mortality after colorectal resection for cancer. Nevertheless, an ideal sarcopaenic indicator is still to be identified.
To evaluate computed tomography (CT) measured total abdominal muscle area (TAMA), total psoas muscle area (TPA), and psoas density (PD) - previously described sarcopaenia indicators - as possible risk factors for postoperative complications in patients after curative colon and rectal resections for colorectal cancer.
Consecutive patients after elective curative colon or rectal resection for cancer at a single institution were divided into cohorts with uncomplicated postoperative course or complications Clavien-Dindo grade I-II (Cl-Di 0-II) and complications Clavien-Dindo grade III-V (Cl-Di III-V). Cohorts were statistically tested for significant differences in TAMA, TPA, and PD calculated from preoperative staging CT scans at the level of the third lumbar vertebra.
Data of 112 patients were analysed from a prospectively run database; 65 underwent colon and 47 rectal resections. PD was significantly higher in the Cl-Di 0-II cohort compared to the Cl-Di III-V for both colon (42.67 ±6.52 vs. 40.11 ±7.57 HU, p = 0.002) and rectal resections (44.08 ±5.86 vs. 43.03 ±5.70HU, p = 0.016). TAMA and TPA failed to show significant differences.
Psoas density is significantly decreased in patients with Clavien-Dindo grade III-V complications after curative resection for colon and rectal cancer. Due to the simplicity and affordability of its assessment from preoperative staging CT scan, it might be considered an optimal sarcopaenic indicator to be utilised in everyday practice.
肌肉减少症似乎是结直肠癌切除术后发病和死亡的预测因素。然而，理想的肌肉减少症指标仍有待确定。
评估计算机断层扫描（CT）测量的腹部总肌肉面积（TAMA）、腰大肌总面积（TPA）和腰大肌密度（PD）——先前描述的肌肉减少症指标——作为接受结直肠癌根治性结肠和直肠切除术后患者术后并发症的可能危险因素。
在单一机构接受择期结直肠癌根治性结肠或直肠切除术后的连续患者被分为术后病程无并发症或Clavien-Dindo I-II级（Cl-Di 0-II）并发症以及Clavien-Dindo III-V级（Cl-Di III-V）并发症的队列。对各队列术前第三腰椎水平分期CT扫描计算出的TAMA、TPA和PD的显著差异进行统计学检验。
对前瞻性运行数据库中的112例患者数据进行分析；65例行结肠切除术，47例行直肠切除术。结肠切除术（42.67±6.52 vs. 40.11±7.57 HU，p = 0.002）和直肠切除术（44.08±5.86 vs. 43.03±5.70 HU，p = 0.016）中，Cl-Di 0-II队列的PD均显著高于Cl-Di III-V队列。TAMA和TPA未显示出显著差异。
结肠癌和直肠癌根治性切除术后出现Clavien-Dindo III-V级并发症的患者腰大肌密度显著降低。由于从术前分期CT扫描评估其简单且经济，它可能被认为是日常实践中可使用的最佳肌肉减少症指标。
