Laparoscopic colorectal cancer surgery combined with Enhanced Recovery After Surgery Protocol (ERAS) reduces the negative impact of sarcopenia on short-term outcomes

• Published in: European journal of surgical oncology Vol. 42; no. 6; pp. 779 - 787
• Main Authors: Pędziwiatr, Michał, MD Ph.D, Pisarska, Magdalena, MD, Major, Piotr, MD Ph.D, Grochowska, Anna, MD, Matłok, Maciej, MD Ph.D, Przęczek, Krzysztof, Stefura, Tomasz, Budzyński, Andrzej, MD, Kłęk, Stanisław, MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2016
• Subjects: Aged; Colorectal cancer; Colorectal Neoplasms; Elective Surgical Procedures; Enhanced recovery after surgery; Fast-track surgery; Hematology, Oncology and Palliative Medicine; Humans; Laparoscopy; Length of Stay; Myosteatosis; Postoperative Complications - epidemiology; Postoperative recovery; Sarcopenia; Surgery; colorectal cancer; preoperative carbohydrate loading; body mass index; American Society of Anaesthesiologists physical status; myosteatosis; ASA; fast-track surgery; LOS; enhanced recovery after surgery; TaTME; American Joint Committee on Cancer; transanal total mesorectal excision; AJCC; postoperative recovery; length of stay in hospital; sarcopenia; ERAS; BMI; CHO-loading; Colorectal cancer; Fast-track surgery; Sarcopenia; Postoperative recovery; Myosteatosis; Enhanced recovery after surgery
• DOI: 10.1016/j.ejso.2016.03.037
• ISSN: 0748-7983

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.