Havan Nuri, Gülmez Selçuk, Senger Aziz Serkan, Uzun Orhan, Dinçer Mürşit, Özduman Ömer, Avan Deniz, Polat Aytaç, Polat Erdal, Duman Mustafa
Department of Radiology, Istanbul Florence Nightingale Ataşehir Hospital, Atasehir, Istanbul, Turkey.
Department of Gastroenterology Surgery, Istanbul KoşUyolu High Specialization Education and Research Hospital, Istanbul, Turkey.
Int J Colorectal Dis. 2025 Apr 21;40(1):96. doi: 10.1007/s00384-025-04863-4.
Sarcopenia has recently been gaining importance due to its role on mortality and mobility in diseases and operations. In this study, we aimed to evaluate the effect of sarcopenia on major postoperative complications in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancy.
In this longitudinal cohort study included 202 patients treated between January 2018 and September 2023, with 52 undergoing prophylactic procedures. Peritoneal metastases originated from colorectal, gastric, and ovarian cancer; peritoneal mesothelioma; mucinous adenocarcinoma of the appendix; and endometrial cancer. Age, sex, body mass index (BMI), length of hospital stay (LOS), peritoneal cancer index (PCI), competency of cytoreduction (CC), operation time, and primary peritoneal carcinomatosis were recorded. All variables were analyzed according to the presence of major complications and sarcopenia.
Significant associations were found between major complications and sarcopenia (p = 0.002), PCI (p = 0.036), operation time (p = 0.015), and LOS (p < 0.001). In sarcopenic patients, significant associations were found with sex (p = 0.035), age (p = 0.025), and BMI (p = 0.001). Multivariate Cox regression analysis identified sarcopenia as an independent risk factor for major complications, tripling the likelihood (p = 0.005). Additionally, PCI score (p = 0.008) and LOS (p < 0.001) were independent risk factors.
This study underscores sarcopenia as an independent risk factor for major complications in CRS/HIPEC patients, with PCI and LOS as additional risk factors. In sarcopenic patients, pre-operative evaluation should be done carefully and post-operative risks should be kept in mind.
由于肌肉减少症在疾病和手术中的死亡率及活动能力方面所起的作用，其近来愈发受到重视。在本研究中，我们旨在评估肌肉减少症对接受减瘤手术（CRS）及热灌注化疗（HIPEC）治疗腹膜表面恶性肿瘤患者术后主要并发症的影响。
在这项纵向队列研究中，纳入了2018年1月至2023年9月期间接受治疗的202例患者，其中52例接受了预防性手术。腹膜转移瘤起源于结直肠癌、胃癌和卵巢癌；腹膜间皮瘤；阑尾黏液腺癌；以及子宫内膜癌。记录患者的年龄、性别、体重指数（BMI）、住院时间（LOS）、腹膜癌指数（PCI）、减瘤效果（CC）、手术时间和原发性腹膜癌病情况。根据是否存在主要并发症和肌肉减少症对所有变量进行分析。
发现主要并发症与肌肉减少症（p = 0.002）、PCI（p = 0.036）、手术时间（p = 0.015）和LOS（p < 0.001）之间存在显著关联。在肌肉减少症患者中，发现与性别（p = 0.035）、年龄（p = 0.025）和BMI（p = 0.001）存在显著关联。多因素Cox回归分析确定肌肉减少症是主要并发症的独立危险因素，使发生可能性增加两倍（p = 0.005）。此外，PCI评分（p = 0.008）和LOS（p < 0.001）也是独立危险因素。
本研究强调肌肉减少症是CRS/HIPEC患者发生主要并发症的独立危险因素，PCI和LOS为其他危险因素。对于肌肉减少症患者，应仔细进行术前评估并牢记术后风险。
