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Multicenter Study
. 2023 Nov;27(11):1091-1098.
doi: 10.1007/s10151-023-02769-3. Epub 2023 May 3.

CT-derived measures of muscle quantity and quality predict poorer outcomes from elective colorectal surgery: a UK multicentre retrospective cohort study

J E M Blackwell  1   2 , P J J Herrod  3   4 , B Doleman  3   4 , H Boyd-Carson  5 , D Dolan  6   7 , L Wheldon  8   9 , S R Brown  8   9 , A Banerjea  10   4 , S Moug  6   7 , J N Lund  3   4 ; POMPOMM Collaborative
Collaborators, Affiliations
Multicenter Study

CT-derived measures of muscle quantity and quality predict poorer outcomes from elective colorectal surgery: a UK multicentre retrospective cohort study

J E M Blackwell et al. Tech Coloproctol. 2023 Nov.

Abstract

Purpose: To assess whether preoperative radiologically defined lean muscle measures are associated with adverse clinical outcomes in patients undergoing elective surgery for colorectal cancer.

Methods: This retrospective UK-based multicentre data collection study identified patients having had colorectal cancer resection with curative intent between January 2013 to December 2016. Preoperative computed-tomography (CT) scans were used to measure psoas muscle characteristics. Clinical records provided postoperative morbidity and mortality data.

Results: This study included 1122 patients. The cohort was separated into a combined group (patients with both sarcopenia and myosteatosis) and others group (either sarcopenia or myosteatosis, or neither). For the combined group, anastomotic leak was predicted on univariate (OR 4.1, 95% CI 1.43-11.79; p = 0.009) and multivariate analysis (OR 4.37, 95% CI 1.41-13.53; p = 0.01). Also for the combined group, mortality (up to 5 years postoperatively) was predicted on univariate (HR 2.41, 95% CI 1.64-3.52; p < 0.001) and multivariate analysis (HR 1.93, 95% CI 1.28-2.89; p = 0.002). A strong correlation exists between freehand-drawn region of interest-derived psoas density measurement and using the ellipse tool (R2 = 81%; p < 0.001).

Conclusion: Measures of lean muscle quality and quantity, which predict important clinical outcomes, can be quickly and easily taken from routine preoperative imaging in patients being considered for colorectal cancer surgery. As poor muscle mass and quality are again shown to predict poorer clinical outcomes, these should be proactively targeted within prehabilitation, perioperative and rehabilitation phases to minimise negative impact of these pathological states.

Keywords: Lean muscle; Myosteatosis; Psoas muscle; Sarcopenia.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose. No funding was received for conducting this study.

Figures

Fig. 1
Fig. 1
Psoas muscle measurement. Freehand region of interest (ROI) drawn bilaterally (blue). Example of ellipse tool use for ROI on right psoas muscle body (red)
Fig. 2
Fig. 2
Graph showing the correlation between freehand-drawn mean psoas density (HU) and single ellipse (HU) used to capture psoas density on the same slice at L3
Fig. 3
Fig. 3
Kaplan–Meier chart showing mortality over time. Red line = Combined group (both sarcopenia and myosteatosis), Blue line = Others (rest of patients in study), Red/Blue shaded areas 95% confidence intervals
See this image and copyright information in PMC

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References

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