Body composition among patients undergoing surgery for colorectal cancer

Postoperative changes in body composition after laparoscopic and open resection of colorectal liver metastases: data from the randomized OSLO-COMET trial

BACKGROUND

Low muscle mass is negatively associated with survival in patients undergoing surgery for colorectal cancer. Current evidence is limited regarding whether the surgical approach for liver resection of colorectal metastasis impacts postoperative changes in body composition and whether preoperative body composition can impact complication rate and survival.

METHOD

This study included patients previously included in the randomized OSLO-COMET trail where patients was allocated to laparoscopic or open liver resection for colorectal liver metastasis. CT scans 0-3 months before and 2-6 months after liver resection were segmented with the artificial intelligence-based tool BodySegAI to measure skeletal muscle mass (SM), visceral adipose tissue (VAT), and inter- and intramuscular adipose tissue (IMAT). SM, VAT and IMAT was compared between the open and laparoscopic group and as predictors for 5-year survival and postoperative complications.

RESULTS

This study included 216 patients, median age was 67, 127 (59%) were male, 91 (42%) had primary tumor in rectum and 86 (40%) had multiple liver metastasis. There was no significant difference in postoperative change in SM, VAT or IMAT between those undergoing laparoscopy or open surgery. In multivariate analysis, high preoperative IMAT was a predictor for increased risk of postoperative complications (HR (95% CI): 1.045 (CI 95%: 1.003-1.089), p = 0.034). Moreover, postoperative increase in IMAT was a negative predictor for 5-year survival (HR (95%CI):1.009 (1.003-1.016), p = 0.003).

CONCLUSION

Postoperative change in body composition did not differ between patients randomly assigned to open or laparoscopic liver resection for colorectal metastasis. High preoperative IMAT was associated with an increased risk of postoperative complications.

Low blood orexin concentration as a predictor of increased nutritional risk and all-cause mortality after surgery for colorectal cancer

Introduction

Orexin regulates food intake, as well as the development and progression of neoplasms.

Aim

The aim of this study was to determine associations between nutritional risk and status and neoplasm stage and prognosis in patients who underwent surgery for colorectal cancer (CRC).

Material and methods

In 84 consecutive patients undergoing surgery for CRC, serum orexin, nutritional risk and body composition (assessed by bioelectrical impedance analysis and cross-sectional area determined using abdominal CT) were evaluated before the operation and 3 months after the surgery. The long-term follow-up lasted 1296.0 ±617.7 days.

Results

Compared to CRC patients with a serum orexin concentration lower than the cutoff value (197.9 pg/ml) determined in ROC curve analysis in prediction of all-cause mortality during long-term follow-up, those with orexin concentrations equal to or higher than the cutoff value were, at baseline and at the 3-month visit, more likely to have a lower score on the nutritional NRS2002 and a higher score on functional scales, greater handgrip strength, and higher skeletal muscle mass, and were less likely to suffer perioperative complications and all-cause mortality (OR = 0.34; 95% CI: 0.13-0.89; p = 0.026) during the follow-up period. No statistically significant differences in tumor size, histopathological grade or clinical stage were found between CRC patient groups divided according to orexin blood concentration.

Conclusions

Serum orexin concentrations were found to be statistically significantly associated with patients' nutritional risk and status before surgery and at a 3-month follow-up visit, and with all-cause mortality during the 3.6-year follow-up.

Influence of body composition assessment with bioelectrical impedance vector analysis in cancer patients undergoing surgery

Background

Malnutrition is common in patients undergoing surgery for cancers and is a risk factor for postoperative outcomes. Body composition provides information for precise nutrition intervention in perioperative period for improving patients' postoperative outcomes.

Objection

The aim was to determine changes in parameters of body composition and nutritional status of cancer patients during perioperative period.

Methods

A total of 92 patients diagnosed with cancer were divided into gastrointestinal and non-gastrointestinal cancer group according to different cancer types. The patients body composition assessed by bioelectrical impedance vector analysis (BIVA) on the day before surgery, postoperative day 1 and 1 day before discharge. The changes between two groups were compared and the correlation between body composition and preoperative serum nutritional indexes was analyzed.

Results

The nutritional status of all patients become worse after surgery, and phase angle (PA) continued to decrease in the perioperative period. Fat-free mass (FFM), fat-free mass index (FFMI), skeletal muscle mass (SMM), extracellular water (ECW), total body water (TBW), hydration, and body cell mass (BCM) rise slightly and then fall in the postoperative period in patients with gastrointestinal cancer, and had a sustained increase in non-gastrointestinal patients, respectively (P<0.05). Postoperative body composition changes in patients with gastrointestinal cancer are related to preoperative albumin, pre-albumin, hemoglobin, and C-reactive protein (P<0.05), whereas postoperative body composition changes in patients with non-gastrointestinal cancer are related to age (P<0.05).

Conclusions

Significant changes in body composition both in patients with gastrointestinal cancer and non-gastrointestinal cancer during perioperative period are observed. Changes in body composition for the cancer patients who undergoing surgery are related to age and preoperative serum nutrition index.

Skeletal Muscle Change During Neoadjuvant Therapy and Its Impact on Prognosis in Patients With Gastrointestinal Cancers: A Systematic Review and Meta-Analysis

Background

Gastrointestinal cancers are the most common malignant tumors worldwide. As the improvement of survival by surgical resection alone for cancers is close to the bottleneck, recent neoadjuvant therapy has been emphasized and applied in the treatment. Despite the advantage on improving the prognosis, some studies have reported neoadjuvant therapy could reduce skeletal muscle and therefore affect postoperative outcomes. However, the conclusions are still controversial.

Methods

PubMed, CINAHL, Embase, and Cochrane Library were searched from inception to September 2, 2021. The inclusion criteria were observational studies, published in English, of individuals aged ≥18 years who underwent neoadjuvant therapy with gastrointestinal cancers and were assessed skeletal muscle mass before and after neoadjuvant therapy, with sufficient data on skeletal muscle change or the association with clinical outcomes. Meta-analysis was conducted by using the STATA 12.0 package when more than two studies reported the same outcome.

Results

A total of 268 articles were identified, and 19 studies (1,954 patients) were included in the review. The fixed effects model showed that the risk of sarcopenia increased 22% after receiving neoadjuvant therapy (HR=1.22, 95% CI 1.14, 1.31, Z=4.286, P&lt;0.001). In the random effects model, neoadjuvant therapy was associated with skeletal muscle loss, with a standardized mean difference of -0.20 (95% CI -0.31, -0.09, Z=3.49, P&lt;0.001) and a significant heterogeneity (I2 =62.2%, P&lt;0.001). Multiple meta regression indicated that population, neoadjuvant therapy type, and measuring tool were the potential sources of heterogeneity. The funnel plot revealed that there was no high publication bias in these studies (Begg’s test, P=0.544) and the sensitivity analysis showed stable results when separately excluding studies. For the postoperative outcomes, the results revealed that muscle loss during neoadjuvant therapy was significantly related to overall survival (HR=2,08, 95% CI =1.47, 2.95, Z=4.12, P&lt;0.001, I2 = 0.0%), but not related to disease-free survival and other short-term outcomes.

Conclusions

This systematic review and meta-analysis revealed that skeletal muscle decreased significantly during neoadjuvant therapy in patients with gastrointestinal cancers and skeletal muscle loss was strongly associated with worse overall survival. More high-quality studies are needed to update and valid these conclusions in a more specific or stratified way.

Systematic Review Registration

[https://www.crd.york.ac.uk/PROSPERO/], identifier PROSPERO (CRD42021292118)