Background: Preoperative low skeletal muscle mass and density are associated with increased postoperative morbidity in patients undergoing curative colorectal cancer (CRC) surgery. However, the long-term effects of low skeletal muscle mass and density remain uncertain. Methods: Patients with stage I-III CRC undergoing surgery, enrolled in a prospective observational cohort study, were included. Skeletal muscle mass and density were measured on CT. Patients with high and low skeletal muscle mass and density were compared regarding postoperative complications, disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). Results: In total, 816 patients (53.9% males, median age 70) were included; 50.4% had low skeletal muscle mass and 64.1% low density. The severe postoperative complication rate was significantly higher in patients with low versus high skeletal muscle and density (20.9% versus 13.6%, p = 0.006; 20.0% versus 11.8%, p = 0.003). Low skeletal muscle mass (OR 1.91, p = 0.018) and density (OR 1.87, p = 0.045) were independently associated with severe postoperative complications. Ninety-day mortality was higher in patients with low skeletal muscle mass and density compared with patients with high skeletal muscle mass and density (3.6% versus 1.7%, p = 0.091; 3.4% versus 1.0%, p = 0.038). No differences in DFS were observed. After adjustment for covariates such as age and comorbidity, univariate differences in OS and CSS diminished. Conclusions: Low skeletal muscle mass and density are associated with short-term, but not long-term, outcome in patients undergoing CRC surgery. These findings recommend putting more emphasis on preoperative management of patients at risk for surgical complications, but do not support benefit for long-term outcome.

Additional Metadata
Keywords Cancer-specific survival, Colorectal cancer, Muscle density, Overall survival, Sarcopenia
Persistent URL dx.doi.org/10.1016/j.ejso.2018.05.029, hdl.handle.net/1765/108856
Journal European Journal of Surgical Oncology
Citation
van Vugt, J.L.A, Coebergh van den Braak, R.R.J, Lalmahomed, Z.S, Vrijland, W.W, Dekker, J.W.T, Zimmerman, D.D.E, … IJzermans, J.N.M. (2018). Impact of low skeletal muscle mass and density on short and long-term outcome after resection of stage I-III colorectal cancer. European Journal of Surgical Oncology. doi:10.1016/j.ejso.2018.05.029