Merboth Felix, Müller-Oerlinghausen Miriam, Nebelung Heiner, Bogner Andreas, Pecqueux Mathieu, Salisch Nadja, Distler Marius, Plodeck Verena, Hoffmann Ralf-Thorsten, Fritzmann Johannes, Weitz Jürgen, Kirchberg Johanna
Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.
J Cachexia Sarcopenia Muscle. 2025 Oct;16(5):e70065. doi: 10.1002/jcsm.70065.
Sarcopenia, characterized by loss of skeletal muscle mass and strength, is prevalent in patients undergoing treatment for colorectal cancer. Sarcopenia's prevalence in patients with cancer can reach up to 50% and is known to exacerbate postsurgical complications and affect long-term oncological outcomes. This study examined whether minimally invasive surgery (MIS) offers protective benefits against postoperative sarcopenia compared with open surgery in patients undergoing rectal cancer resection.
This retrospective analysis included 145 patients who underwent open or minimally invasive (laparoscopic or robot-assisted) rectal resections at the University Hospital Dresden between 2013 and 2021. Confounding variables were adjusted using propensity score matching. The skeletal muscle index (SMI) and psoas muscle thickness per height (PMTH) were analysed in preoperative and postoperative computed tomography scans to measure changes in skeletal muscle mass. Potential risk factors for muscle loss were evaluated, and oncological long-term outcome was analysed.
The results indicate that oncological rectal resection did not result in pronounced postoperative muscle loss. No significant difference between the open and MIS groups in terms of postoperative muscle loss over 3 years postoperatively could be detected. Wound healing disorders were identified as the most significant independent risk factors for muscle loss (SMI loss > 10%). In contrast, neither the type of surgical technique nor the presence of a protective loop ileostomy significantly influenced the development of postoperative muscle loss. Patients who experienced a > 10% SMI loss within the first year had significantly poorer overall and disease-free survival. The 1-year survival rate was 93.3% in the group with high SMI loss compared with 100.0% in the group with low SMI loss (p = 0.435). The 3-year (66.7% vs. 95.6%, HR 8.75, 95% CI 1.855-41.286, p = 0.006) and 5-year (44.4% vs. 93.3%, HR 11.072, 95% CI 2.414-50.782, p = 0.002) survival rates were significantly lower in patients with high SMI loss. Patients with high SMI loss had an increased likelihood of recurrence and metastasis.
Although MIS did not confer a protective advantage against postoperative muscle loss in patients with rectal cancer, the findings highlight the critical role of maintaining muscle mass in improving survival outcomes. Postoperative muscle loss appears to be a marker of aggressive tumour behaviour, and interventions aimed at minimizing muscle loss, such as enhanced nutritional support, may improve the long-term patient prognosis. Future studies should explore interventional strategies to mitigate sarcopenia in this population.
肌肉减少症以骨骼肌质量和力量丧失为特征，在接受结直肠癌治疗的患者中普遍存在。癌症患者中肌肉减少症的患病率可达50%，已知会加剧术后并发症并影响长期肿瘤学结局。本研究探讨了在接受直肠癌切除术的患者中，与开放手术相比，微创手术（MIS）是否对术后肌肉减少症具有保护作用。
这项回顾性分析纳入了2013年至2021年期间在德累斯顿大学医院接受开放或微创（腹腔镜或机器人辅助）直肠切除术的145例患者。使用倾向评分匹配法对混杂变量进行调整。在术前和术后计算机断层扫描中分析骨骼肌指数（SMI）和每身高的腰大肌厚度（PMTH），以测量骨骼肌质量的变化。评估肌肉损失的潜在危险因素，并分析肿瘤学长期结局。
结果表明，肿瘤性直肠切除术并未导致明显的术后肌肉损失。在术后3年的肌肉损失方面，开放手术组和MIS组之间未检测到显著差异。伤口愈合障碍被确定为肌肉损失（SMI损失>10%）的最显著独立危险因素。相比之下，手术技术类型和保护性回肠造口术的存在均未显著影响术后肌肉损失的发生。在第一年内SMI损失>10%的患者总体生存率和无病生存率显著较差。SMI损失高的组1年生存率为93.3%，而SMI损失低的组为100.0%（p=0.435）。SMI损失高的患者3年（66.7%对95.6%，HR 8.75，95%CI 1.855-41.286，p=0.006）和5年（44.4%对93.3%，HR 11.072，95%CI 2.414-50.782，p=0.002）生存率显著较低。SMI损失高的患者复发和转移的可能性增加。
尽管MIS对直肠癌患者术后肌肉损失没有保护优势，但研究结果突出了维持肌肉质量在改善生存结局中的关键作用。术后肌肉损失似乎是侵袭性肿瘤行为的一个标志，旨在尽量减少肌肉损失的干预措施，如加强营养支持，可能会改善患者的长期预后。未来的研究应探索减轻该人群肌肉减少症的干预策略。
