Rastgeldi Hasan Burak, Arslanca Tufan, Batur Halitcan, Aytekin Okan, Tokalıoğlu Abdurrahman Alp, Kılıç Fatih, Turan Taner
Clinic of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Türkiye.
Clinic of Gynecologic Oncology, Ankara Bilkent City Hospital, Ankara, Türkiye.
J Turk Ger Gynecol Assoc. 2025 Jun 10;26(2):121-129. doi: 10.4274/jtgga.galenos.2025.2025-4-6.
The association between skeletal muscle mass and postoperative morbidity in cancer patients has been demonstrated, but the results are not conclusive. The study aims to determine the predictive efficacy of rectus abdominis muscle (RAM) and psoas major muscle (PMM) thickness and other factors such as age, American Society of Anesthesiologists (ASA) score, operation duration, obesity, preoperative inflammatory markers, and pathological findings for postoperative morbidity.
One hundred forty-one patients who underwent total abdominal hysterectomy + bilateral salpingo-oophorectomy + retroperitoneal lymphadenectomy + omentectomy for endometrial cancer were assessed retrospectively. Standard procedures (antibiotic prophylaxis and thromboembolism prophylaxis) were applied pre- and postoperatively, and the thicknesses of the RAM and PMM were measured by computed tomography. Postoperative morbidity was defined in the 3-month postoperative period as patients treated with a diagnosis of postoperative infection, those who developed pulmonary complications, thromboembolic complications, lymphatic drainage disorders, intracranial hemorrhage, and mortality.
The mean thickness of the right-left RAM in the morbidity group was 7.4±2.1 mm, and 8.2±2.1 mm in the group without morbidity (p=0.038). On the other hand, the thickness of the right-left PMM was similar in both groups. When the predictive cut-off value for RAM thickness was 7.52 mm, the sensitivity, specificity, and negative and positive predictive values were 54.2%, 65.6%, 73.5%, and 44.8%, respectively. Advanced age, high ASA score, and extended operation duration were associated with an increased risk of morbidity in univariate analysis. However, multivariate analysis revealed that only age and operation duration were independent risk factors for postoperative morbidity [respectively, odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01-1.12, p=0.033 and OR: 1.003, 95% CI: 1.0003-1.007, p=0.039].
Age and operation duration were identified as independent risk factors for predicting postoperative morbidity. However, it has been shown that a more comprehensive evaluation, including RAM thickness and ASA score alongside these two factors, could provide more definitive results.
已证实癌症患者骨骼肌质量与术后发病率之间存在关联，但结果尚无定论。本研究旨在确定腹直肌（RAM）和腰大肌（PMM）厚度以及年龄、美国麻醉医师协会（ASA）评分、手术时长、肥胖、术前炎症标志物和病理结果等其他因素对术后发病率的预测效能。
回顾性评估141例行子宫内膜癌全腹子宫切除术+双侧输卵管卵巢切除术+腹膜后淋巴结清扫术+大网膜切除术的患者。术前和术后均采用标准程序（抗生素预防和血栓栓塞预防），并通过计算机断层扫描测量RAM和PMM的厚度。术后发病率定义为术后3个月内被诊断为术后感染、发生肺部并发症、血栓栓塞并发症、淋巴引流障碍、颅内出血及死亡的患者。
发病组左右RAM的平均厚度为7.4±2.1mm，未发病组为8.2±2.1mm（p=0.038）。另一方面，两组左右PMM的厚度相似。当RAM厚度的预测临界值为7.52mm时，敏感性、特异性、阴性预测值和阳性预测值分别为54.2%、65.6%、73.5%和44.8%。单因素分析显示，高龄、高ASA评分和延长手术时长与发病风险增加相关。然而，多因素分析显示，仅年龄和手术时长是术后发病的独立危险因素[比值比（OR）分别为：1.06，95%置信区间（CI）：1.01-1.12，p=0.033；OR：1.003，95%CI：1.0003-1.007，p=0.039]。
年龄和手术时长被确定为预测术后发病率的独立危险因素。然而，研究表明，包括RAM厚度和ASA评分在内的更全面评估，连同这两个因素，可能会提供更明确的结果。
