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Sarcopenia is Associated with Chemotherapy Toxicity in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Colorectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Despite the positive survival results of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), criticisms have been put forward regarding the safety of this treatment as a result of a high morbidity rate. Muscle depletion (sarcopenia) is associated with the occurrence of postoperative complications. The purpose of this study was to determine the association between sarcopenia and postoperative morbidity after CRS-HIPEC for peritoneal carcinomatosis from colorectal cancer by distinguishing the complications linked to CRS itself and those associated with chemotherapy (HIPEC) toxicities.

Methods

Data concerning 97 consecutive patients who had undergone CRS-HIPEC were recorded. We analyzed the events occurring within 30 days after surgery that were prospectively recorded in a database. Sarcopenia was assessed using the L3 muscle index on computed tomography performed during the 2 months preceding surgery.

Results

The sarcopenic patients experienced significantly more chemotherapy toxicities (57 vs. 26 %; p = 0.004) and especially neutropenia (36 vs. 17 %; p = 0.04) than their nonsarcopenic counterparts. There was no difference in complications linked to the CRS procedure between sarcopenic and nonsarcopenic patients. In the multivariate analysis, sarcopenia was the only parameter independently associated with the risk of chemotherapy toxicity (odds ratio 3.97; 95 % confidence interval 1.52–10.39; p = 0.005).

Conclusions

Despite the local administration of chemotherapy, systemic toxicity was observed in sarcopenic patients after CRS-HIPEC. This relationship favors new treatment strategies with white blood cell growth factors or chemotherapy dosing based on muscle value.

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Acknowledgments

Supported in part by a French Society of Clinical Nutrition and Metabolism (SFNEP) and Baxter SA award received December 2013. The authors thank Lorna Saint Ange for editing.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Gustave-Roussy Cancer Campus, University of Paris Sud, Villejuif, France

    Stéphanie Chemama MD, Diane Goéré MD, PhD & Dominique Elias MD, PhD

  2. Biostatistics and Epidemiology Unit, Gustave-Roussy Cancer Campus, University of Paris Sud, Villejuif, France

    Mohamed Amine Bayar MSc & Emilie Lanoy PhD

  3. INSERM U1018, CESP, University of Paris-Saclay, Villejuif, France

    Mohamed Amine Bayar MSc

  4. Department of Radiology, Gustave-Roussy Cancer Campus, University of Paris Sud, Villejuif, France

    Samy Ammari MD

  5. Intensive Care Unit, Gustave-Roussy Cancer Campus, University of Paris Sud, Villejuif, France

    Annabelle Stoclin MD

  6. Department of Supportive Care, Gustave-Roussy Cancer Campus, University of Paris Sud, Villejuif, France

    Bruno Raynard MD

  7. Department of Ambulatory Care, Gustave-Roussy Cancer Campus, University of Paris Sud, Villejuif, France

    Sami Antoun MD

Authors
  1. Stéphanie Chemama MD
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  2. Mohamed Amine Bayar MSc
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  6. Diane Goéré MD, PhD
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  7. Dominique Elias MD, PhD
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  8. Bruno Raynard MD
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  9. Sami Antoun MD
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Correspondence to Sami Antoun MD.

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Chemama, S., Bayar, M.A., Lanoy, E. et al. Sarcopenia is Associated with Chemotherapy Toxicity in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Colorectal Cancer. Ann Surg Oncol 23, 3891–3898 (2016). https://doi.org/10.1245/s10434-016-5360-7

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  • DOI: https://doi.org/10.1245/s10434-016-5360-7

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