Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan;
Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan.
Anticancer Res. 2024 Sep;44(9):4019-4029. doi: 10.21873/anticanres.17231.
BACKGROUND/AIM: Postoperative changes in body composition, especially loss of muscle mass, often occur in gastrointestinal cancer patients. Few studies have reported perioperative changes in the body composition of patients with colorectal cancer. Therefore, this study aimed at clarifying changes in body composition during the perioperative period and identifying risk factors for skeletal muscle mass loss in patients with colorectal cancer.
This prospective observational study included 148 patients who underwent robot- or laparoscopic-assisted surgery for colorectal cancer.
The rate of change in body composition at discharge was -6.25% for body fat, with a higher rate of decrease than that for skeletal muscle mass (-3.30%; p=0.0006) and body water mass (-2.66%; p=0.0001). Similarly, even at one month postoperatively, body fat mass (-8.05%) was reduced at a greater rate than skeletal muscle mass (-2.02% p=0.0001) and body water mass (-1.33% p=0.0001).The site-specific percent change in limb skeletal and trunk muscle mass at discharge was the greatest in the lower extremities at -5.37%, but one month after surgery, the upper extremities had the greatest change at -4.44%. The Prognostic Nutritional Index (PNI) influenced skeletal muscle mass loss at discharge [odds ratio (OR)=2.6; 95% confidence interval (CI)=1.30-5.58], while diabetes (OR=4.1; 95%CI=1.40-12.43) and ileostomy (OR=6.7; 95%CI=1.45-31.11) influenced skeletal muscle loss one month postoperatively.
Preoperative and postoperative nutritional guidance/intervention and body part-specific rehabilitation should be provided to prevent skeletal muscle mass loss in patients with low PNI, diabetes, and those undergoing ileostomy.
背景/目的：胃肠道癌症患者术后常发生身体成分变化，尤其是肌肉量减少。鲜有研究报告结直肠癌患者围手术期身体成分的变化。因此，本研究旨在阐明结直肠癌患者围手术期身体成分的变化，并确定骨骼肌量减少的风险因素。
本前瞻性观察研究纳入了 148 例接受机器人或腹腔镜辅助结直肠癌手术的患者。
出院时身体成分的变化率为体脂-6.25%，下降幅度高于骨骼肌量（-3.30%；p=0.0006）和身体水分量（-2.66%；p=0.0001）。同样，即使在术后 1 个月，体脂质量（-8.05%）的减少速度也快于骨骼肌量（-2.02%；p=0.0001）和身体水分量（-1.33%；p=0.0001）。出院时肢体骨骼肌和躯干肌肉质量的部位特异性百分比变化以下肢最大，为-5.37%，但术后 1 个月，上肢的变化最大，为-4.44%。预后营养指数（PNI）影响出院时骨骼肌量的减少[比值比（OR）=2.6；95%置信区间（CI）=1.30-5.58]，而糖尿病（OR=4.1；95%CI=1.40-12.43）和回肠造口术（OR=6.7；95%CI=1.45-31.11）影响术后 1 个月时骨骼肌的丢失。
对于 PNI 较低、患有糖尿病和接受回肠造口术的患者，应在术前和术后提供营养指导/干预和针对身体特定部位的康复治疗，以预防骨骼肌量减少。
