Patients Having Major Abdominal Cancer Surgery Exhibit Significant Acute Muscle Wasting

Abstract

Background: Postoperative myopenia (acute muscle loss) is a significant concern following major cancer resection surgery, contributing to prolonged recovery, increased dependency and impaired quality of life. Despite its clinical relevance, the mechanisms underlying postoperative myopenia and its potential mediators remain poorly understood. This study aims to evaluate the acute changes in muscle size, strength and activity following major cancer surgery and to explore the role of insulin resistance and selenium deficiency as potential mediators of these alterations.

Methods: A prospective cohort study was conducted involving 52 patients undergoing elective open major abdominal surgery for cancer. Preoperative and postoperative assessments included measurements of rectus femoris cross-sectional area (RFCSA) via ultrasound, handgrip strength (HGS), sniff nasal inspiratory pressure (SNIP) and physical activity using an accelerometer. Blood samples were analysed for markers of muscle metabolism, systemic inflammation, insulin resistance and selenium levels. Statistical analyses were performed to compare preoperative and postoperative values and to explore correlations between these measures and clinical outcomes.

Results: A significant reduction in RFCSA was observed in 50% of patients, with a median decrease of 10.2% within the first week post-surgery, which persisted at the 6-week follow-up. HGS and SNIP also showed significant declines postoperatively, and reduced physical activity was associated with greater muscle loss. Insulin resistance and postoperative selenium depletion were associated with greater reductions in RFCSA.

Conclusion: Major cancer surgery is associated with significant acute muscle loss, which is not fully recovered by 6 weeks postoperatively. Insulin resistance and selenium deficiency may contribute to this muscle loss. Further research is needed to investigate potential interventions to prevent or mitigate postoperative myopenia.

Keywords: cancer surgery; insulin resistance; muscle loss; muscle wasting; myopenia; postoperative recovery.

FIGURE 1

CONSORT diagram for the MAMAS study.

FIGURE 2

Changes in muscle bulk, rectus femoris cross sectional area (RFCSA) following surgery. (A) Box‐and‐whisker plot (median, IQR, range) of rectus femoris cross sectional area (RFCSA) preoperatively, at Day 7 or discharge, and at follow‐up, n = 41. ****p < 0.001 Friedman test with Dunn's correction. (B) Relative change (mean and standard deviation) in RFCSA % change at Day 7 or discharge postoperatively and at follow‐up, n = 41. ****p < 0.0001 ANOVA with Dunnett's multiple comparisons test.

FIGURE 3

Change in muscle strength, handgrip and sniff nasal inspiratory pressure following surgery. (A) Handgrip strength (HGS) preoperatively, at Day 7 or discharge, and at follow‐up (mean and standard deviation, n = 39. ***p < 0.0005 **** p < 0.0001 ANOVA with Bonferroni's correction). (B) Sniff nasal inspiratory pressure (SNIP) preoperatively, at Day 7 or discharge, and at follow‐up (mean and standard deviation, n = 38. ****p < 0.0001 ANOVA with Bonferroni's correction).

FIGURE 4

Scatterplots showing relationships between (A)handgrip strength (right) in (kilograms) measured at Day 7 or day of discharge [x] and distance walked in 6 min (metres) [y] when measured on the same day, n = 38. Pearson's r = 0.51, p = 0.001. (B) Percentage change in rectus femoris cross sectional area (RFCSA) between Day 7 or day of discharge and preop [x] and sum of activity counts in first 48 h postop [y], n = 51. Spearman's r = 0.45, p = 0.001.

FIGURE 5

Effect of metabolic parameters on postoperative muscle wasting. (A) Change in rectus femoris CSA (%: mean and standard deviation) in those who had insulin resistance (HOMA2 score > 1.39), and those who did not. *Unpaired t‐test, p = 0.017, n = 46. (B) Change in rectus femoris CSA (%: mean and standard deviation) in those who had low postoperative selenium (plasma selenium < 0.75 μmol/L), and those who did not. **Unpaired t‐test, p = 0.063, n = 51.

FIGURE 6

Plasma levels of selected proposed determinants of muscle wasting associated with disease comparing preop, postop and at discharge. (A) Tumour necrosis factor‐related weak inducer of apoptosis (TWEAK). (B) Myostatin. (C) Insulin‐like growth factor‐1 (IGF‐1). (D) Growth and differentiation factor‐15 (GDF‐15). All data represented as median, IQR, range (N = 48–51, Friedman test with Dunn's correction ****p < 0.001, ***p < 0.001, *p < 0.05).