Physical performance has a strong association with poor surgical outcome in older patients with colorectal cancer.

Autor: Souwer ET; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands. Electronic address: e.souwer@hagaziekenhuis.nl., Moos SI; Department of Radiology, Haga Hospital, The Hague, the Netherlands., van Rooden CJ; Department of Radiology, Haga Hospital, The Hague, the Netherlands., Bijlsma AY; Department of Geriatrics, University Medical Center Utrecht, the Netherlands., Bastiaannet E; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands., Steup WH; Department of Surgery, Haga Hospital, The Hague, the Netherlands., Dekker JWT; Department of Surgery, Reinier De Graaf Gasthuis, Delft, the Netherlands., Fiocco M; Department of Biomedical Sciences, Leiden University Medical Center, Leiden, the Netherlands; Mathematical Institute Leiden University, the Netherlands., van den Bos F; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands; Department of Geriatrics, University Medical Center Utrecht, the Netherlands., Portielje JE; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2020 Mar; Vol. 46 (3), pp. 462-469. Date of Electronic Publication: 2019 Nov 28.
DOI: 10.1016/j.ejso.2019.11.512
Abstrakt: Background: Low lumbar skeletal muscle mass and density have been associated with adverse outcomes in different populations with colorectal cancer (CRC). We aimed to determine whether skeletal muscle mass, density, and physical performance are associated with postoperative complications and overall survival (OS) in older CRC patients.
Methods: We analysed consecutive patients (≥70 years) undergoing elective surgery for non-metastatic CRC (stage I-III). Lumbar skeletal muscle mass and muscle density were measured using abdominal CT-images obtained prior to surgery. Low skeletal muscle mass and low muscle density were defined using commonly used thresholds and by gender-specific quartiles (Q). The preoperative use of a mobility aid served as a marker for physical performance. Cox regression proportional hazard models were used to investigate the association between the independent variables and OS.
Results: 174 Patients were included (mean age 78.0), with median follow-up 2.6 years. 36 Patients (21%) used a mobility aid preoperatively. Low muscle density (Q1 vs Q4) and not muscle mass was associated with worse postoperative outcomes, including severe complications (p < 0.05). Use of a mobility aid was associated with more complications, including severe complications (39% vs 17%, p = 0.004) and OS (HR 2.65, CI 1.29-5.44, p = 0.01). However, patients with mobility aid use and low skeletal muscle mass had worse OS (HR 5.68, p = 0.003).
Conclusion: Low skeletal muscle density and not muscle mass was associated with more complications after colorectal surgery in older patients. Physical performance has the strongest association for poor surgical outcomes and should be investigated when measuring skeletal muscle mass and density.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose.
(Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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