S184: preoperative sarcopenia is associated with worse short-term outcomes following transanal total mesorectal excision (TaTME) for rectal cancer.

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Tytuł:: S184: preoperative sarcopenia is associated with worse short-term outcomes following transanal total mesorectal excision (TaTME) for rectal cancer.
Autorzy:: Springer JE; Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA.
Beauharnais C; Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA.
Chicarilli D; Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA.
Coderre D; Department of Orthopedic Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Crawford A; Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA.
Baima JA; Department of Orthopedic Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
McIntosh LJ; Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA.
Davids JS; Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA.
Sturrock PR; Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA.
Maykel JA; Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA.
Alavi K; Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA. .
Źródło:: Surgical endoscopy [Surg Endosc] 2022 Jul; Vol. 36 (7), pp. 5408-5415. Date of Electronic Publication: 2022 Jan 06.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: 1992- : New York : Springer
Original Publication: [Berlin] : Springer International, c1987-
MeSH Terms:: Laparoscopy*
Rectal Neoplasms*/complications
Rectal Neoplasms*/surgery
Sarcopenia*/complications
Sarcopenia*/surgery
Transanal Endoscopic Surgery*/methods
Female ; Humans ; Male ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Rectum/surgery ; Retrospective Studies ; Treatment Outcome
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Contributed Indexing:: Keywords: Laparoscopy; Malnutrition; Rectal cancer; Sarcopenia; TaTME
Entry Date(s):: Date Created: 20220106 Date Completed: 20220603 Latest Revision: 20220818
Update Code:: 20240104
DOI:: 10.1007/s00464-021-08872-6
PMID:: 34988741
: Czasopismo naukowe

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Introduction: Malnutrition and deconditioning impact postoperative morbidity and mortality. Computed tomography (CT) body composition variables are used as markers of nutritional status and sarcopenia. The objective of this study is to evaluate the impact of sarcopenia, using CT variables, on postoperative outcomes following transanal total mesorectal excision (TaTME) for rectal cancer.
Methods: This was an institutional retrospective cohort analysis of consecutive rectal cancer patients who underwent TaTME between April 2014 and May 2020. Psoas muscle index (PMI) was calculated from diagnostic CT scans. Based on previous studies, patients in the lowest PMI tertile by gender were considered sarcopenic. Fisher's exact and Mann-Whitney U test were used to compare categorical and continuous variables, respectively. Readmission rates and postoperative complications were compared between groups. Backward stepwise logistic regression was used to determine the association between sarcopenia and 30-day postoperative complications.
Results: 85 patients were analyzed, of which 63% were male, with a median age of 59 (IQR: 51-65), and median BMI of 28 (IQR: 24-32). Of the entire cohort, 34% (n = 29) were sarcopenic (median PMI 5.39 IQR: 4.49-6.71). No significant difference in baseline characteristics between sarcopenic and nonsarcopenic patients were observed. 55% of sarcopenic patients experienced a complication within 30 days compared to 24% of nonsarcopenic patients (p = 0.01). 41% of sarcopenic patients required hospital readmission within 30 days compared to 17% of their nonsarcopenic counterparts (p = 0.014). Sarcopenic patients also experienced significantly higher rates of post-operative small bowel obstruction (10% vs. 0%, p = 0.04). Multivariable analyses identified that sarcopenic patients have a fourfold increase in odds of experiencing a 30-day postoperative complication (OR: 4.44, 95%CI: 1.6-12.4, p < 0.05) after adjusting for gender.
Conclusion: Preoperative sarcopenia is associated with increased 30-day postoperative complications following TaTME for rectal cancer. Postoperative complications can have serious oncologic implications by delaying adjuvant chemotherapy. Therefore, preoperative recognition of sarcopenia prior to undergoing TaTME for rectal cancer may provide an opportunity for early intervention with prehabilitation programs.
(© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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