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

  • 2021 SAGES Oral
  • Published:
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Abstract

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.

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Authors and Affiliations

  1. Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA

    Jeremy E. Springer, Catherine Beauharnais, Allison Crawford, Jennifer S. Davids, Paul R. Sturrock, Justin A. Maykel & Karim Alavi

  2. Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA

    Derek Chicarilli & Lacey J. McIntosh

  3. Department of Orthopedic Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Danielle Coderre & Jennifer A. Baima

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  1. Jeremy E. Springer
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  2. Catherine Beauharnais
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Contributions

Dr. JES, Dr. KA, and Dr. CB were responsible for the conception, design, data analysis, and editing of this manuscript. Dr. JES, Dr. DC and Ms. DC were responsible for data collection and Ms. AC was responsible for data analysis. Dr. JAB, Dr. LJM, Dr. JSD, Dr. PRS, and Dr. JAM contributed to the design, interpretation of the data, and revisions for the final approval of this manuscript. All authors provided substantial contributions to this manuscript.

Corresponding author

Correspondence to Karim Alavi.

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Disclosures

Justin A. Maykel MD—Applied Medical Clinical Educator. Jeremy E. Springer MD, Catherine Beauharnais MD, Derek Chicarilli MD, Danielle Coderre BS, Allison Crawford MS, Jennifer A. Baima MD, Lacey J. McIntosh DO, Jennifer S. Davids MD, Paul R. Sturrock MD, and Karim Alavi MD have no conflict of interest or financial ties to disclose.

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Springer, J.E., Beauharnais, C., Chicarilli, D. et al. S184: preoperative sarcopenia is associated with worse short-term outcomes following transanal total mesorectal excision (TaTME) for rectal cancer. Surg Endosc 36, 5408–5415 (2022). https://doi.org/10.1007/s00464-021-08872-6

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