Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery?

Abstract

Sarcopenia, or loss of skeletal muscle mass and quality, has been studied as part of aging and adverse health outcomes in elderly patients but has only recently been evaluated as a separate condition in cancer patients and important indicator of adverse outcomes. Currently, its definition and method of assessment are still being debated. Sarcopenia within an increasingly obese population has led to a subgroup with sarcopenic obesity, at even higher risk of adverse outcomes. Yet, sarcopenia often goes undiagnosed in these patients, hidden beneath higher body mass index. Identifying sarcopenic and sarcopenic obese subpopulations would allow for more effective treatment plans and potential avoidance of suboptimal outcomes, as well as the chance to intervene and combat these modifiable risk factors. This review will examine available literature on the definition and methods of evaluating sarcopenia and sarcopenic obesity, summarize the effectiveness of sarcopenia and sarcopenic obesity as predictors of outcomes after gastrointestinal cancer surgery, including colorectal cancer resection, liver resection, and pancreatic resection, and outline strategies to minimize the impact of sarcopenia. It is clear that untreated sarcopenia and sarcopenic obesity can be associated with suboptimal post-operative outcomes, especially infections and disease-free or overall survival.

Keywords: Body composition; Colorectal cancer; Hepatectomy; Malnutrition; Obesity; Oncologic; Pancreatic cancer; Sarcopenia; Surgery; Surgical oncology.

Fig. 1

Comparison of sarcopenic and non-sarcopenic computed tomography images at the third lumbar vertebral level. A comparison of two cirrhotic patients with identical BMI (32 kg/m²). Red color indicates skeletal muscle: rectus abdominis, oblique and lateral abdominal muscles, psoas, and paraspinal muscles. The patient on the left is sarcopenic with L3mi of 49.82 cm²/m²; the patient on the right is not sarcopenic with L3mi of 70.8 cm²/m². In their study of 112 cirrhotic patients, Montano-Loza et al. used abdominal CT images taken at the third lumbar vertebrae and cutoffs provided by Baumgartner et al. in 1998

Fig. 2

Example segmented L3 computed tomography image for skeletal muscle assessment of patient undergoing hepatic resection. L3mi computed tomogram shows highlighted areas of subcutaneous (green) and intra-abdominal fat (yellow) and skeletal muscle mass (red). van Vledder et al. found a variety of body compositions within their population of 196 patients who underwent hepatic resection for colorectal liver metastases