C. S. Lau1, N. Ghalyaie1,2, R. S. Chamberlain1,2 1Abrazo Central Hospital, Abrazo Community Health Network,Phoenix, AZ, USA 2Cancer Surgical Services Division, Valley Surgical Clinics,Phoenix, AZ, USA
Introduction: Colorectal cancer is the third leading cause of cancer-related deaths in the United States, accounting for over 50,000 deaths a year. Colorectal resection is the standard treatment for most colorectal cancer patients, and carries well-known risks including anastomotic leak, abscess, wound infection, etc. Sarcopenia is the progressive loss of skeletal muscle mass and strength, and is common in colorectal cancer patients. This meta-analysis assesses the impact of sarcopenia on colorectal cancer patient surgical outcomes.
Methods: A comprehensive literature search of all published studies evaluating the impact of sarcopenia in colorectal cancer patients undergoing surgery was conducted using PubMed, Cochrane Central Registries of Controlled Studies, and Google Scholar. Keywords searched included combinations of ‘sarcopenia’, ‘colorectal cancer’, ‘surgery’, and ‘outcomes’. Outcomes analyzed included total complications, major complications (Clavien-Dindo grade ≥3), anastomotic leaks, in-hospital/30-day mortality, 30-day readmission rates, and length of stay.
Results: Twelve studies including 2,787 patients (1,306 sarcopenic and 1,481 non-sarcopenic) were analyzed. Sarcopenia was associated with significantly higher rates of total complications (OR 1.856; 95% CI, 1.426-2.415, p<0.001), but not major complications graded Clavien-Dindo ≥3 (OR 1.635; 95% CI, 0.891-3.001; p=0.112) or anastomotic leaks (OR 0.806; 95% CI, 0.529-1.229; p=0.317). Sarcopenia was also associated with significantly higher rates of mortality (OR 3.439; 95% CI, 1.718-6.884; p<0.001) and longer lengths of stay (MD 1.491 days; 95% CI, 0.715-2.268; p<0.001). No significant increase in 30-day readmission rates was observed (OR 1.740; 95% CI, 0.830-3.646; p=0.142).
Conclusion: Sarcopenia among colorectal cancer patients undergoing surgery is associated with a significant increase in total complications, mortality, and length of stay. Sarcopenia is a poor prognostic factor in colorectal cancer patients undergoing surgery, and preoperative muscle mass assessments may have significant value in predicting and improving patient outcomes.
