Colonic Neoplasms, Sarcopenia
Conditions
Keywords
sarcopenia, myosteatosis, enhanced recovery after surgery, colorectal cancer, minimally invasive surgery, complications
Brief summary
So far, the impact of sarcopenia has been analysed only in patients undergoing traditional surgical procedures (laparotomy) or those with metastatic spread. As the ERAS protocol combined with minimally invasive access decreases postoperative metabolic disorders, it seems possible that it can limit the deleterious impact of sarcopenia as well. The aim of this study was to investigate whether the use of ERAS protocol in colorectal cancer patients influences the postoperative risk due to sarcopenia.
Detailed description
The prospective observation with post-hoc analysis of 171 consecutive colorectal cancer patients was performed. In all patients 16-item ERAS protocol was applied. Contrast-enhanced CT scan was performed preoperatively. From each scan one CT image at the level of L3 vertebra was transferred in Digital Imaging and Communications in Medicine format (DICOM) and anonymised. Firstly, the threshold range between -29 and +150 Hounsfield units was set to semi-automatically outline muscle areas, - 150 to - 50 was used for visceral adipose tissue areas, and -190 to -30 was used for subcutaneous and intermuscular adipose tissue areas. Secondly, the software calculated the surface area (cm2) of each tissue. The L3 skeletal muscle area (rectus abdominis, external and internal obliques, transversus abdominis, quadratus lumborum, psoas, erector spinae) normalized for patient height was used to calculate skeletal muscle index (SMI) (cm2/m2). According to Martin et al. sarcopenia was defined as a SMI \<41 cm2/m2 in women, \<43 cm2/m2 in men with a BMI \<25 kg/m2, and \<53 cm2/m2 in men with a BMI \>25 kg/m2 (10). To assess for myosteatosis the mean radiodensity of a L3 psoas muscle was measured. The cut-off for patients with BMI \<25 kg/m2 was \<41 Hounsfield units and \<33 Hounsfield units for patients with BMI ≥25 kg/m2. For the purposes of further analysis the entire group of patients was divided into subgroups depending on the presence of sarcopenia or myosteatosis.
Interventions
None listed
Sponsors
Jagiellonian University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* confirmed adenocarcinoma of colon or rectum * complete preoperative radiology assessment with abdominal CT scan * laparoscopic resection * perioperative care according to ERAS principles
Exclusion criteria
* unavailability of a preoperative abdominal CT scan (within 30 days prior surgery) * emergency or initially open surgery * patients treated with endoscopic techniques: transanal endoscopic microsurgery (TEM), transanal total mesorectal excision (TaTME) * concomitant inflammatory bowel diseases.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Complications | up to 30 days post surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Compliance with ERAS protocol (%) | up to discharge from hospital, an average 6 days | — |
| Tolerance of oral diet on the 1st postoperative day | up to discharge from hospital, an average 6 days | tolerating at least 800 ml of clear water/fluids and 1 oral nutritional supplement within the first 24h postoperative hours |
| Time to first flatus | up to discharge from hospital, an average 6 days | — |
| Hospital length of stay (days) | up to discharge from hospital, an average 6 days | — |
| Mobilization on the 1st postoperative day | up to discharge from hospital, an average 6 days | walking at least 100 m without assistance, at least 6h out of bed (sitting, walking) |
| Need for opioid analgesia postoperatively | up to discharge from hospital, an average 6 days | no need for opioid drug administration (any kind, dosage or administration route) |
| Readmission rate | up to 30 days post surgery | — |
Countries
Poland
Outcome results
None listed