Kotek Jiri, Lochman Petr, Hulek Michal, Sirovy Miroslav, Merkl Tomas, Cermakova Eva, Kotkova Katerina, Paral Jiri, Dusek Tomas
Department of Field Surgery, University of Defence, Military Faculty of Medicine, Hradec Kralove, Czech Republic.
Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
J Clin Imaging Sci. 2024 Jul 24;14:26. doi: 10.25259/JCIS_43_2024. eCollection 2024.
Although sarcopenia is recognized as one of the risk factors for increased morbidity after resection for colorectal cancer, the question of the most appropriate way to identify and quantify it is still unresolved.
This is a retrospective unicentric study following patients undergoing elective resection of the rectum for carcinoma with available staging computed tomography (CT) of the trunk. Psoas muscle density (PMD) and its area relative to patient height psoas muscle index (PMI) at the level of inferior vertebral end plate of third lumbar vertebra (L3) were assessed using an initial staging CT scan of the trunk. Post-operative complications, evaluated according to the Clavien-Dindo classification, and blood samples on post-operative days (POD) 3 and 5 were also recorded in the study population. Patients were divided into groups with complicated and uncomplicated post-operative course, and observed parameters were then statistically compared.
The correlation of PMI values with the development of post-operative complications was not confirmed in a data set of 206 patients. PMD values were found to be borderline statistically significant in patients with complicated post-operative course, while in the group of patients with severe complications (Clavien-Dindo III-IV), there was no statistically significant difference in PMI or PMD values. The same results were obtained when comparing patients with anastomotic leak (AL). It was confirmed that operations on the lower rectum are riskier for the development of post-operative complications. The secondary objective of our study regarding serum C-reactive protein (CRP) levels of 3 and 5 POD gave us the answer in the form of cutoff values of 115.7 mg/L (3 POD) and 76 mg/L (5 POD).
PMD appears to be a promising tool for predicting post-operative morbidity in patients after rectal resection, but a clear consensus on the method of measurement, interpretation of results and cutoff values is needed. Lower rectal resections are burdened with a higher risk of post-operative complications, especially AL. Monitoring of CRP levels remains an important marker in the prediction of AL due to its negative predictive value.
尽管肌肉减少症被认为是结直肠癌切除术后发病率增加的危险因素之一，但如何以最合适的方式识别和量化它的问题仍未解决。
这是一项回顾性单中心研究，对接受择期直肠癌切除术且有躯干分期计算机断层扫描（CT）的患者进行随访。使用躯干的初始分期CT扫描评估第三腰椎（L3）下椎体终板水平的腰大肌密度（PMD）及其相对于患者身高的面积腰大肌指数（PMI）。研究人群还记录了根据Clavien-Dindo分类评估的术后并发症以及术后第3天和第5天的血样。将患者分为术后病程复杂和不复杂的组，然后对观察到的参数进行统计学比较。
在206例患者的数据集中，未证实PMI值与术后并发症的发生存在相关性。发现术后病程复杂的患者PMD值在统计学上接近显著，而在严重并发症（Clavien-Dindo III-IV级）患者组中，PMI或PMD值无统计学显著差异。比较有吻合口漏（AL）的患者时也得到了相同的结果。证实低位直肠癌手术发生术后并发症的风险更高。我们研究关于术后第3天和第5天血清C反应蛋白（CRP）水平的次要目标，以115.7 mg/L（术后第3天）和76 mg/L（术后第5天）的临界值形式给出了答案。
PMD似乎是预测直肠切除术后患者术后发病率的一个有前景的工具，但在测量方法、结果解释和临界值方面需要明确的共识。低位直肠切除术术后并发症风险更高，尤其是AL。由于其阴性预测价值，监测CRP水平仍然是预测AL的一个重要指标。
