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Value of sarcopenia assessed by computed tomography for the prediction of postoperative morbidity following oncological colorectal resection: A comparison with the malnutrition screening tool.
Clin Nutr ESPEN. 2018 04; 24:114-119.CN

Abstract

BACKGROUND

Computed tomography (CT) can be used for accurate estimation of whole-body muscle mass and muscle density and for detection of sarcopenia. The goal of this study was to evaluate the additional value of CT measured sarcopenia and muscle attenuation alongside the Malnutrition Universal Screening Tool (MUST) for the prediction of post-operative morbidity after oncological colorectal resection, whilst correcting for known risk factors.

METHODS

A prospective cohort study of 80 patients undergoing elective colorectal surgery in the Netherlands. Patients were screened for nutritional risk upon admission using the MUST. Additionally, preoperative CT scans were used to determine skeletal muscle mass for the detection of sarcopenia and muscle attenuation. Univariate and multivariable analyses were performed to evaluate associations between the MUST, muscle attenuation and sarcopenia on the one hand and post-operative complications measured by the Clavien-Dindo score on the other hand.

RESULTS

American Society of Anesthesiology-classification (ASA) ≥3, age ≥70, MUST ≥2 and lower than median muscle attenuation were significantly associated with a higher risk for postoperative complications (Clavien-Dindo score ≥2) (p ≤ 0.05), whereas sarcopenia was not (p = 0.59). Multivariate analyses showed that only MUST ≥2 remained significantly associated with postoperative complications when corrected for age (p = 0.03, OR 5.8, 95%CI 1.1-29.6), but not when corrected for age ≥70 and ASA ≥3. Muscle attenuation and sarcopenia were not significantly associated with postoperative complications.

CONCLUSION

Our results suggest that using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery. It also underlines the importance of currently implemented easy-to-use nutritional screening tools (MUST) and raises the question of the evaluation of muscle quality versus quantity in body composition imaging. However, further research is needed to investigate the role of sarcopenia for predicting outcome after colorectal surgery, and investigate the role of muscle attenuation measurements for the prediction of muscle function. CATEGORY OF SUBMISSION: observational study.

Authors+Show Affiliations

Department of General, Gastrointestinal and Transplant Surgery, Uniklinik Aachen, Aachen, Germany. Electronic address: Gregory.kroft@gmail.com.Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands.Department of Surgery, VieCuri Medical Centre Centre, Venlo, The Netherlands.Department of Surgery, VieCuri Medical Centre Centre, Venlo, The Netherlands.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29576348

Citation

van der Kroft, G, et al. "Value of Sarcopenia Assessed By Computed Tomography for the Prediction of Postoperative Morbidity Following Oncological Colorectal Resection: a Comparison With the Malnutrition Screening Tool." Clinical Nutrition ESPEN, vol. 24, 2018, pp. 114-119.
van der Kroft G, Bours DMJL, Janssen-Heijnen DM, et al. Value of sarcopenia assessed by computed tomography for the prediction of postoperative morbidity following oncological colorectal resection: A comparison with the malnutrition screening tool. Clin Nutr ESPEN. 2018;24:114-119.
van der Kroft, G., Bours, D. M. J. L., Janssen-Heijnen, D. M., van Berlo, D. C. L. H., & Konsten, D. J. L. M. (2018). Value of sarcopenia assessed by computed tomography for the prediction of postoperative morbidity following oncological colorectal resection: A comparison with the malnutrition screening tool. Clinical Nutrition ESPEN, 24, 114-119. https://doi.org/10.1016/j.clnesp.2018.01.003
van der Kroft G, et al. Value of Sarcopenia Assessed By Computed Tomography for the Prediction of Postoperative Morbidity Following Oncological Colorectal Resection: a Comparison With the Malnutrition Screening Tool. Clin Nutr ESPEN. 2018;24:114-119. PubMed PMID: 29576348.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Value of sarcopenia assessed by computed tomography for the prediction of postoperative morbidity following oncological colorectal resection: A comparison with the malnutrition screening tool. AU - van der Kroft,G, AU - Bours,Dr M J L, AU - Janssen-Heijnen,Dr M, AU - van Berlo,Dr C L H, AU - Konsten,Dr J L M, Y1 - 2018/03/02/ PY - 2017/05/31/received PY - 2017/11/16/revised PY - 2018/01/09/accepted PY - 2018/3/27/entrez PY - 2018/3/27/pubmed PY - 2019/7/26/medline KW - Colorectal cancer KW - Colorectal resection KW - Malnutrition KW - Malnutrition Universal Screening Tool KW - Morbidity KW - Nutritional risk KW - Postoperative complications KW - Sarcopenia SP - 114 EP - 119 JF - Clinical nutrition ESPEN JO - Clin Nutr ESPEN VL - 24 N2 - BACKGROUND: Computed tomography (CT) can be used for accurate estimation of whole-body muscle mass and muscle density and for detection of sarcopenia. The goal of this study was to evaluate the additional value of CT measured sarcopenia and muscle attenuation alongside the Malnutrition Universal Screening Tool (MUST) for the prediction of post-operative morbidity after oncological colorectal resection, whilst correcting for known risk factors. METHODS: A prospective cohort study of 80 patients undergoing elective colorectal surgery in the Netherlands. Patients were screened for nutritional risk upon admission using the MUST. Additionally, preoperative CT scans were used to determine skeletal muscle mass for the detection of sarcopenia and muscle attenuation. Univariate and multivariable analyses were performed to evaluate associations between the MUST, muscle attenuation and sarcopenia on the one hand and post-operative complications measured by the Clavien-Dindo score on the other hand. RESULTS: American Society of Anesthesiology-classification (ASA) ≥3, age ≥70, MUST ≥2 and lower than median muscle attenuation were significantly associated with a higher risk for postoperative complications (Clavien-Dindo score ≥2) (p ≤ 0.05), whereas sarcopenia was not (p = 0.59). Multivariate analyses showed that only MUST ≥2 remained significantly associated with postoperative complications when corrected for age (p = 0.03, OR 5.8, 95%CI 1.1-29.6), but not when corrected for age ≥70 and ASA ≥3. Muscle attenuation and sarcopenia were not significantly associated with postoperative complications. CONCLUSION: Our results suggest that using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery. It also underlines the importance of currently implemented easy-to-use nutritional screening tools (MUST) and raises the question of the evaluation of muscle quality versus quantity in body composition imaging. However, further research is needed to investigate the role of sarcopenia for predicting outcome after colorectal surgery, and investigate the role of muscle attenuation measurements for the prediction of muscle function. CATEGORY OF SUBMISSION: observational study. SN - 2405-4577 UR - https://www.unboundmedicine.com/medline/citation/29576348/Value_of_sarcopenia_assessed_by_computed_tomography_for_the_prediction_of_postoperative_morbidity_following_oncological_colorectal_resection:_A_comparison_with_the_malnutrition_screening_tool_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-4577(17)30229-2 DB - PRIME DP - Unbound Medicine ER -