Sarcopenia, as Assessed by Psoas Cross-Sectional Area, Is Predictive of Adverse Postoperative Outcomes in Patients Undergoing Colorectal Cancer Surgery.

BACKGROUND Frailty and sarcopenia are important concepts in surgical practice because of their association with adverse postoperative outcomes. Radiologically assessed psoas muscle mass has been proposed as a surrogate for sarcopenia and may be predictive of poor postoperative outcomes. OBJECTIVE This study aimed to determine the association between sarcopenia, as assessed by psoas cross-sectional area, and postoperative outcomes in patients undergoing colorectal cancer surgery. DESIGN This was a retrospective review of patient records from 2014 to 2016. SETTINGS This study was conducted at a single tertiary center. PATIENTS Patients undergoing elective resection of colorectal cancer were included. MAIN OUTCOME MEASURES Sarcopenia was assessed using the total psoas index, calculated by measuring the cross-sectional area of the psoas muscle at the third lumbar vertebra and normalized for patient height. Preoperative and intraoperative variables, including the presence of preoperative sarcopenia, were evaluated as potential risk factors for adverse postoperative outcomes. RESULTS Of 350 patients, 115 (32.9%) were identified as sarcopenic. Sarcopenia was associated with a significantly increased length of stay (13 days vs 7 days; OR, 1.31; 95% CI, 1.23-1.42; p < 0.01) and 1-year mortality (13.9% vs 0.9%; OR, 16.2; 95% CI, 4.34-83.4; p < 0.01). Sarcopenia was also associated with a significant increased risk of any complication (85.2% vs 34.5%; OR, 15.4; 95% CI, 8.39-29.7; p < 0.01) and of major complications (30.4% vs 8.9%; OR, 15.1; 95% CI, 7.16-33.2; p < 0.01). LIMITATIONS This study was limited by its retrospective design and by being conducted in a single institution. Although reduced muscle mass is suggestive of sarcopenia, it does not assess a patient's physical function or other components of the frailty phenotype. CONCLUSION Radiological sarcopenia is an important predictive risk factor for adverse postoperative outcomes in surgical patients. Computed tomography scans, which are routinely performed as part of staging, provide an opportunity to assess for sarcopenia preoperatively. See Video Abstract at http://links.lww.com/DCR/B201. LA SARCOPENIA, EVALUADA POR EL AREA TRANSVERSAL DE PSOAS, PREDICE RESULTADOS POSTOPERATORIOS ADVERSOS EN PACIENTES SOMETIDOS A CIRUGIA DE CANCER COLORECTAL: La fragilidad y la sarcopenia son conceptos importantes en la practica quirurgica debido a su asociacion con los resultados postoperatorios adversos. La masa muscular del psoas evaluada radiologicamente se ha propuesto como un sustituto de la sarcopenia y puede predecir resultados postoperatorios deficientes.Determinar la asociacion entre la sarcopenia, segun lo evaluado por el area transversal del psoas, y los resultados postoperatorios en pacientes sometidos a cirugia de cancer colorrectal.Esta fue una revision retrospectiva de los registros de pacientes de 2014 a 2016.Este estudio se llevo a cabo en un solo centro terciario.Se incluyeron pacientes sometidos a reseccion electiva de cancer colorrectal.La sarcopenia se evaluo utilizando el indice de psoas total (TPI), calculado midiendo el area de la seccion transversal del musculo psoas en la tercera vertebra lumbar y normalizado para la altura del paciente.Se evaluaron las variables preoperatorias e intraoperatorias, incluida la presencia de sarcopenia preoperatoria, como posibles factores de riesgo de resultados postoperatorios adversos.De 350 pacientes, 115 (32,9%) fueron identificados como sarcopenicos. La sarcopenia se asocio con un aumento significativo de la duracion de la estancia (13 dias frente a 7 dias, OR 1.31, IC 95% 1.23-1.42, p < 0.01) y de la mortalidad al ano (13.9% vs 0.9%, OR 16.2, IC 95% 4.34-83.4, p < 0.01). La sarcopenia tambien se asocio con un aumento significativo del riesgo de cualquier complicacion (85.2% vs 34.5%, OR 15.4, IC 95% 8.39-29.7, p < 0.01) y de complicaciones mayores (30.4% vs 8.9%, OR 15.1 IC 95% 7.16-33,2, p < 0,01).Este estudio estuvo limitado por su diseno retrospectivo y por el hecho de que se realizo en una sola institucion. Aunque la reduccion de la masa muscular es un indicio de sarcopenia, no evalua la funcion fisica del paciente ni otros componentes del fenotipo de fragilidad.La sarcopenia radiologica es un importante factor de riesgo predictivo para resultados postoperatorios adversos en pacientes quirurgicos. Las tomografias computarizadas, que se realizan rutinariamente como parte de la estadificacion, brindan la oportunidad de evaluar la sarcopenia antes de la operacion. Consulte Video Resumen en http://links.lww.com/DCR/B201. (Traduccion-Dr. Gonzalo Hagerman).