THE IMPACT OF SARCOPENIA AND BODY MASS INDEX ON OUTCOME AFTER CYTOREDUCTION AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY
Alykhan Premji, Andrew Dyer, Paxton Dickson, Evan S. Glazer, David Shibata, Jeremiah Deneve*
Surgery, UTHSC, Memphis, TN
Background
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has improved outcomes for peritoneal carcinomatosis (PC) but is associated with significant morbidity. Muscle depletion (sarcopenia) is associated with postoperative morbidity. We investigated the impact of sarcopenia on outcomes after CRS/HIPEC.
Methods
A retrospective review was performed and sarcopenia was assessed using the L3 psoas muscle index (PI) on preoperative imaging within three months of CRS/HIPEC. Sarcopenia was defined as PI < 0.41 cm2/m2in females and PI < 0.43 cm2/m2in males.
Results
Fifty-seven patients (age 56 years, 70% female and 70% Caucasian) underwent CRS/HIPEC for appendiceal (56%), colon (18%), ovarian (16%) or other malignancies (10%). The peritoneal cancer index score was 11.0 (1-39), 96% underwent completeness of cytoreduction score of 0/1, and 49 (86%) required multivisceral resection. Median body mass index (BMI) was 31.3 (19-51). Twenty-three % had a BMI <25, 23% had a BMI 25-29.9 and 54% had a BMI > 30., The median PI was 0.63 (0.28-1.33). Eleven patients (19%) had sarcopenia. Sarcopenia was associated with lower BMI (25.2 vs 31.7, p=0.002), preoperative albumin (2.8 vs 3.6, p=0.003), and lower PI (0.40. vs 0.68, p<0.0001) but had no association with morbidity (36% vs 39%, p=0.687) or mortality (0% vs 4%, p=0.497). Patients with sarcopenia were more likely to be discharged to inpatient rehabilitation center (20% vs 2%, p=0.027). Presence of sarcopenia did not portend worse overall survival on multivariate analysis.
Conclusion
The impact of sarcopenia on postoperative morbidity and outcomes for CRS/HIPEC remains inconclusive. While our data suggests there is a delayed recovery necessitating inpatient rehabilitation, further analysis is needed to determine the significance of sarcopenia on PC.
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