A. M. Blakely1, S. Brown2, D. J. Grand2, T. J. Miner1 2Brown University School Of Medicine,Department of Radiology,Providence, RI, USA 1Brown University School Of Medicine,Department Of Surgery,Providence, RI, USA
Introduction:
Sarcopenia, defined as the degenerative loss of muscle quality with age, has been shown to be associated with worse outcomes following resection of various cancer types. Sarcopenia is usually assessed by evaluating psoas muscle density and/or cross-sectional area at the level of the third or fourth lumbar vertebra. To date, sarcopenia has not been evaluated as a predictor of outcomes following palliative surgery.
Methods:
Retrospective analysis of a prospective database of all palliative surgery patients receiving an operation from January 2004 to December 2012 was performed. Those patients with a pre-operative abdominopelvic computed tomography (CT) and follow-up of at least 6 months were selected for analysis. CT scans were evaluated by a resident and attending radiologist for mean total psoas muscle cross-sectional area and density. Time from CT to operation, primary tumor type, and post-operative complications were recorded.
Results:
From January 2004 to December 2012, 57 patients were identified as having undergone a palliative procedure with prior abdominopelvic CT scan available for evaluation. Of 57 patients, 27 (47.4%) were male, with median age of 63 years. Median time from CT scan to operation was 10 days. Regarding primary tumor type, 15 (26.3%) were pancreas, 9 (15.8%) colon, 7 (12.3%) stomach, 4 (7.0%) lung, 3 (5.3%) ovary, 3 (5.3%) cholangiocarcinoma, and 16 (28.1%) other. Thirty-day post-operative morbidity was 31.6% and mortality was 5.3%. Mean total psoas area was 1622.8 mm2 (range 785.3 to 3641.3 mm2, standard deviation (SD) 586.6), and the mean psoas density was 49.8 Hounsfield units (HU) (range 27.1 to 69.8 HU, SD 9.9). Increasing age was associated with decreased total psoas area (p=0.0027) and decreased psoas density (p=0.0005). However, neither total psoas area nor density were associated with the development of complications (p=0.88 and p=0.48, respectively).
Conclusions:
Sarcopenia, assessed by either psoas muscle area or density, was not associated with complications following palliative surgery. Patient selection for palliative surgery continues to be challenging. Sarcopenia may retain some value in the pre-operative assessment of advanced cancer patients as a component of a frailty index.