M Pędziwiatr1, M Pisarska2, P Major2, A Grochowska3, M Matłok2, K Przęczek2, T Stefura2, A Budzyński2, S Kłęk4. 1. 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Kopernika 21, 31-501, Kraków, Poland. Electronic address: michal.pedziwiatr@uj.edu.pl. 2. 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Kopernika 21, 31-501, Kraków, Poland. 3. Department of Radiology, University Hospital, Kopernika 21, 31-501, Kraków, Poland. 4. Stanley Dudrick Memorial Hospital, Tyniecka 15, 32-050, Skawina, Poland.
Abstract
INTRODUCTION: Progressive skeletal muscle loss (sarcopenia) is a negative prognostic factor in patients treated for colorectal cancer. Nevertheless, the clinical impact of those changes in body composition has been analyzed only in patients undergoing open resections. The aim of the study was to assess whether laparoscopy may eliminate the deleterious prognostic impact of sarcopenia and whether the combination with enhanced recovery after surgery (ERAS) protocol may improve postoperative recovery also in sarcopenic patients. METHODS: The study included 124 (73M/51F, mean age 65.9 years) patients undergoing elective laparoscopic colorectal resection for cancer. In all of them 16-item ERAS protocol was applied. The L3 skeletal muscle area identified on a preoperative CT scan was used to calculate skeletal muscle index and assess for sarcopenia and myosteatosis. The entire study group was divided into groups regarding the presence of sarcopenia or myosteatosis. The outcome measures were: length of hospital stay, complication rate and functional recovery parameters. RESULTS: The prevalence of sarcopenia and myosteatosis was 27.4% and 38.7%, respectively. There was no association between the presence of sarcopenia or myosteatosis and postoperative complications. There were also no differences in the length of stay or readmission rates. Functional recovery (time to first flatus, oral diet tolerance and mobilization) was similar regardless of the presence of muscle depletion. CONCLUSIONS: In contrary to traditional surgical approach, laparoscopy can reduce the negative impact of sarcopenia and myosteatosis on treatment results. ERAS protocol does not affect negatively the surgical outcomes in sarcopenic patients, compared to patients without changes in body skeletal mass.
INTRODUCTION: Progressive skeletal muscle loss (sarcopenia) is a negative prognostic factor in patients treated for colorectal cancer. Nevertheless, the clinical impact of those changes in body composition has been analyzed only in patients undergoing open resections. The aim of the study was to assess whether laparoscopy may eliminate the deleterious prognostic impact of sarcopenia and whether the combination with enhanced recovery after surgery (ERAS) protocol may improve postoperative recovery also in sarcopenic patients. METHODS: The study included 124 (73M/51F, mean age 65.9 years) patients undergoing elective laparoscopic colorectal resection for cancer. In all of them 16-item ERAS protocol was applied. The L3 skeletal muscle area identified on a preoperative CT scan was used to calculate skeletal muscle index and assess for sarcopenia and myosteatosis. The entire study group was divided into groups regarding the presence of sarcopenia or myosteatosis. The outcome measures were: length of hospital stay, complication rate and functional recovery parameters. RESULTS: The prevalence of sarcopenia and myosteatosis was 27.4% and 38.7%, respectively. There was no association between the presence of sarcopenia or myosteatosis and postoperative complications. There were also no differences in the length of stay or readmission rates. Functional recovery (time to first flatus, oral diet tolerance and mobilization) was similar regardless of the presence of muscle depletion. CONCLUSIONS: In contrary to traditional surgical approach, laparoscopy can reduce the negative impact of sarcopenia and myosteatosis on treatment results. ERAS protocol does not affect negatively the surgical outcomes in sarcopenic patients, compared to patients without changes in body skeletal mass.
Authors: Piotr Małczak; Michał Wysocki; Hanna Twardowska; Alicja Dudek; Justyna Tabiś; Piotr Major; Magdalena Pisarska; Michał Pędziwiatr Journal: Obes Surg Date: 2020-04 Impact factor: 4.129
Authors: Michał Pędziwiatr; Piotr Małczak; Piotr Major; Jan Witowski; Beata Kuśnierz-Cabala; Piotr Ceranowicz; Andrzej Budzyński Journal: Med Oncol Date: 2017-06-01 Impact factor: 3.064
Authors: Linda B M Weerink; Anouk van der Hoorn; Barbara L van Leeuwen; Geertruida H de Bock Journal: J Cachexia Sarcopenia Muscle Date: 2020-03-03 Impact factor: 12.910
Authors: Piotr Major; Michał Wysocki; Grzegorz Torbicz; Natalia Gajewska; Alicja Dudek; Piotr Małczak; Michał Pędziwiatr; Magdalena Pisarska; Dorota Radkowiak; Andrzej Budzyński Journal: Obes Surg Date: 2018-02 Impact factor: 4.129
Authors: Michał Pędziwiatr; Judene Mavrikis; Jan Witowski; Alexandros Adamos; Piotr Major; Michał Nowakowski; Andrzej Budzyński Journal: Med Oncol Date: 2018-05-09 Impact factor: 3.064