title: Sarcopenia as a predictor of complications in penile cancer patients undergoing inguinal lymph node dissection.
abstract: OBJECTIVE
  Lymphadenectomy (LND) is part of the surgical management of penile cancer but causes significant perioperative morbidity. We determined whether sarcopenia, a novel marker of nutritional status, is a predictor of postoperative complications after LND.
  
  
  METHODS
  Seventy-nine patients underwent LND for penile cancer from 1999 to 2014, and 43 had available preoperative abdominal imaging. Skeletal muscle index (SMI) was calculated on axial computed tomography images at the third lumbar vertebrae, and an SMI of 55 cm(2)/m(2) was used to classify patients as sarcopenic versus not. This classification was then correlated with postoperative complications and survival.
  
  
  RESULTS
  Median lumbar SMI was 54.7 cm(2)/m(2) with 22 (51.2 %) patients categorized as sarcopenic versus 21 (48.8 %) who were not. Twenty-seven postoperative complications occurred in 20 patients within 30 days, of which 11 (40.7 %) were major (Clavien score ≥IIIa) and 16 (59.3 %) were minor. The most common complications were wound dehiscence (25.9 %), wound infection (18.5 %), lymphocele (18.5 %), and flap necrosis (14.8 %). On univariate analysis, the presence of sarcopenia, nodal disease, and lymphovascular invasion were predictors of postoperative complications. On multivariate analysis, only sarcopenia was an independent predictor of 30-day complications [p = 0.038; 95 % confidence interval (CI) 1.1-21.1]. Although sarcopenia was not statistically associated with worse overall survival (OS), there was a trend toward poorer outcomes in these patients.
  
  
  CONCLUSIONS
  Sarcopenia can be a useful prognostic tool to predict the likelihood of postoperative complications after LND for penile cancer. Preoperative nutritional supplementation may help reduce complication rates in the future.
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Zargar-Shoshtari
authors.affiliation: Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Jamie T
authors.initials: JT
authors.lastname: Caracciolo
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Richard
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Poch
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: Pow-Sang
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA. philippe.spiess@moffitt.org.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
mesh_terms: D000368:Aged; D001706:Biopsy; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010412:Penile Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D055948:Sarcopenia / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
keywords: Complications; Inguinal lymph node dissection; Penile cancer; Sarcopenia