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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2016

Open Access 01-08-2016 | Colorectal Cancer

Skeletal Muscle Changes After Elective Colorectal Cancer Resection: A Longitudinal Study

Authors: George Malietzis, MBBS, Msc, MRCS, Andrew C. Currie, MBBS, MRCS, Neil Johns, MBBS, MRCS, Kenneth C. Fearon, MD, FRCS, Ara Darzi, PhD, FRCS, Robin H. Kennedy, MS, FRCS, Thanos Athanasiou, PhD, FECTS, John T. Jenkins, MD, MRCS

Published in: Annals of Surgical Oncology | Issue 8/2016

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Abstract

Background

Muscle depletion is a poor prognostic indicator in colorectal cancer (CRC) patients, but there were no data assessing comparative temporal body composition changes following elective CRC surgery. We examined patient skeletal muscle index trajectories over time after surgery and determined factors that may contribute to those alterations.

Methods

Patients diagnosed with CRC undergoing elective surgical resection between 2006 and 2013 were included in this study. Image analysis of serial computed tomography (CT) scans was used to calculate lumbar skeletal muscle index (LSMI). A multilevel mixed-effect linear regression model was applied using STATA (version 12.0) using the xtmixed command to fit growth curve models (GCM) for LSMI and time.

Results

In 856 patients, a total of 2136 CT images were analyzed; 856 (38.2 %) were preoperative. A quadratic GCM with random intercept and random slope for patients’ LSMI was identified that demonstrated laparoscopy produces a positive change on the LSMI curve [estimate = 0.17 cm2/m2, standard error (SE) 0.06 cm2/m2; p = 0.03], whereas Union for International Cancer Control (UICC) stage III + IV disease contributed to a negative curve change (estimate = −0.19 cm2/m2, SE 0.09 cm2/m2; p = 0.03). Older age (p < 0.01), female gender (p < 0.01), higher American Society of Anesthesiologists (ASA) score (p < 0.01), and altered systemic inflammatory response [SIR] (p = 0.03) were factors significantly associated with lower values of LSMI over time.

Conclusion

In patients undergoing CRC surgery, laparoscopy and the absence of a significantly elevated SIR favored preservation and restoration of skeletal muscle, postoperatively. These emerging data may permit the development of new treatment protocols whereby monitoring and modification of body composition has therapeutic potential.
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Metadata
Title
Skeletal Muscle Changes After Elective Colorectal Cancer Resection: A Longitudinal Study
Authors
George Malietzis, MBBS, Msc, MRCS
Andrew C. Currie, MBBS, MRCS
Neil Johns, MBBS, MRCS
Kenneth C. Fearon, MD, FRCS
Ara Darzi, PhD, FRCS
Robin H. Kennedy, MS, FRCS
Thanos Athanasiou, PhD, FECTS
John T. Jenkins, MD, MRCS
Publication date
01-08-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5188-1

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