Sarcopenia and the clinicopathological outcomes in laparoscopic rectal surgery

Abstract

Aims: Models for predicting outcomes in rectal cancer surgery are inconsistent and improving their accuracy for individualised care is needed. While radiologically determined sarcopenia (low lean muscle mass) is associated with poorer outcomes from chemoradiotherapy, there were no studies on its effect on minimally invasive surgery. We therefore examined its relationship with the clinicopathological outcomes of laparoscopic rectal cancer resections. Methods: The prospectively accrued database was used to identify rectal cancer resections performed over a 2-year period. Of the 90 rectal cancers patients, 45 underwent laparoscopic resections and the data on clinicopathological features were collected. The CT scans were examined retrospectively to determine their sarcopenia score (graded 1-4), defined by the quartiles of the HUACs (Hounsfield Unit Average Calculation) of the average area of both psoas muscles. Results: Low sarcopenia scores (<2) were associated preoperatively with age (r=0.305, p=0.043), WHO performance status (r=0.479, p<0.001), and type 2 diabetes mellitus (r=0.379, p=0.01). They also correlated postoperatively to Clavien-Dindo Morbidity Scores of 2 or more (r=0.316, p=0.046; OR 1.27, p=0.043), low TME grades (r=-0.316, p=0.046; OR 0.78, p=0.012) and conversion to open surgery (r=0.305, p=0.043; OR 1.61, p=0.049). Conclusions: Sarcopenia is a useful marker in laparoscopic rectal cancer resections and therefore requires further evaluation towards improving model predictions of surgical outcomes.