The impacts of sarcopenia on outcomes of patients with left-sided colon or rectal cancer after curative surgery

Abstract

Abstract Background The impacts of nutritional status on and short-term and long-term survival of patients with left-sided colon or rectal cancer have not been exhaustively investigated. Thus, we accomplished the present study to evaluate the effects of sarcopenia on short-term and long-term outcomes of patients with left-sided colon or rectal cancer. Methods Patients with pathologically diagnosed stage I, II and III left-sided colon or rectal cancer who had undergone curative surgery were studied. The psoas muscle index (PMI) identified by 3D-image analysis of computed tomographic images was the criterion used to diagnose sarcopenia. The cutoff value recommended by Hamaguchi et al. (PMI value < 6.36 cm2/m2 for men and < 3.92 cm2/m2 for women) was adopted to confirm the diagnosis of sarcopenia. According to PMI, each patient was divided into the sarcopenia group (SG) or the non-sarcopenia group (NSG). Then SG was compared with NSG in terms of short-term outcomes and long-term outcomes. Results Among the 939 patients included, 574 ones (61.1%) were confirmed with preoperative sarcopenia. Initially, it was demonstrated that SG was not significantly different from NSG in terms of most baseline characteristics except smaller body mass index (BMI) (P < 0.001), larger tumor size (P < 0.001) and more weight loss (P = 0.029). Then it revealed that SG had a longer hospital stay after surgery (P = 0.040), more intraoperative blood transfusion (P = 0.035), and a higher incidence of anastomotic fistula (P = 0.027), incision infection (P = 0.037) and hypoalbuminemia (P = 0.022). The SG had significantly worse overall survival (OS) (P = 0.016) and recurrence-free survival (RFS) (P = 0.036) than the NSG. Subsequently, by Cox regression analysis, we revealed that preoperative sarcopenia was an independent predictive factor for worse OS (P = 0.0211, HR = 1.367, 95%CI: 1.049–1.782) and RFS (P = 0.045, HR = 1.299, 95%CI: 1.006–1.677). Conclusion Preoperative sarcopenia significantly adversely affected long-term and short-term outcomes of patients with left-sided colon or rectal cancer and preoperative nutrition supplementation may help us improve their long-term and short-term outcomes.