title: Skeletal muscle mass and quality as risk factors for postoperative outcome after open colon resection for cancer.
abstract: BACKGROUND
  The prevalence of colorectal cancer in the elderly is increasing and, therefore, surgical interventions with a risk of potential complications are more frequently performed. This study investigated the role of low skeletal muscle mass (sarcopenia), muscle quality, and the sarcopenic obesity as prognostic factors for postoperative complications and survival in patients with resectable colon cancer.
  
  
  METHODS
  We conducted a retrospective chart review of 91 consecutive patients who underwent an elective open colon resection for cancer with primary anastomosis between 2011 and 2013. Skeletal muscle mass was measured as total psoas area (TPA) and total abdominal muscle area (TAMA) at three anatomical levels on the preoperative CT scan. Skeletal muscle quality was measured using corresponding mean Hounsfield units (HU) for TAMA. Their relation with complications (none vs one or more), severe complications, and survival was analyzed.
  
  
  RESULTS
  The study included 91 patients with a mean age of 71.2 ± 9.7 years. Complications were noted in 55 patients (60 %), of which 15 (16.4 %) were severe. Lower HU for TAMA, as an indicator for impaired skeletal muscle quality, was an independent risk factor for one or more complications (all P ≤ 0.002), while sarcopenic obesity (TPA) was an independent risk factor for severe complications (all P ≤ 0.008). Sarcopenia was an independent predictor of worse overall survival (HR 8.54; 95 % confidence interval (CI) 1.07-68.32).
  
  
  CONCLUSIONS
  Skeletal muscle quality is a predictor for overall complications, whereas sarcopenic obesity is a predictor for severe postoperative complications after open colon resection for cancer. Sarcopenia on itself is a predictor for worse overall survival.
authors.affiliation: Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands.|Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: Boer
authors.affiliation: Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands.|Faculty of Science and Technology, University of Twente, Enschede, Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: de Graaff
authors.affiliation: Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Brusse-Keizer
authors.affiliation: Department of Radiology, Medisch Spectrum Twente, Enschede, Netherlands.
authors.forename: D E
authors.initials: DE
authors.lastname: Bouman
authors.affiliation: Faculty of Science and Technology, University of Twente, Enschede, Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: Slump
authors.affiliation: Department of Internal Medicine-Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Slee-Valentijn
authors.affiliation: Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands. j.klaase@mst.nl.
authors.forename: J M
authors.initials: JM
authors.lastname: Klaase
mesh_terms: D000368:Aged; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D018482:Muscle, Skeletal / Q000473:pathology*; D009765:Obesity / Q000150:complications; D009929:Organ Size; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications; D016896:Treatment Outcome
keywords: Colon cancer; Sarcopenia