Laparoscopic colorectal cancer surgery reduces the adverse impacts of sarcopenia on postoperative outcomes: a propensity score-matched analysis

Abstract

Background

Sarcopenia is a negative predictor for postoperative recovery. This study was performed to evaluate the short-term outcomes of laparoscopic surgery in colorectal cancer patients with sarcopenia.

Methods

We conducted a study of patients who underwent curative surgeries for colorectal cancer in two centers from July 2014 to July 2018. In order to reduce selection bias, we conducted a propensity score matching analysis. Preoperative characteristics including age, gender, anemia, body mass index, hypoalbuminemia, America society of anesthesiology scores, epidural anesthesia, operative procedure, stoma, tumor location, and combined resection were incorporated in the model, and produced 58 matched pairs. The third lumbar skeletal muscle mass, handgrip strength, and 6 m usual gait speed were measured to define sarcopenia. Short-term outcomes were compared between the two groups.

Results

In a total of 1136 patients, 272 had sarcopenia diagnosed, and 227 were further analyzed in this study. Among them, 108 patients underwent laparoscopic colorectal surgery and 119 underwent open colorectal surgery. In the matched cohort, the clinical characteristics of the two groups were well matched. The laparoscopic group had significantly reduced overall complications (15.5% vs. 36.2%, P = 0.016) and shorter postoperative hospital stays (10.5 vs. 14, P = 0.027). Subgroup analysis of postoperative complications showed that the incidence of surgical complications (P = 0.032) was lower in the laparoscopic group. Hospitalization costs (P = 0.071) and 30-day readmissions (P = 0.215) were similar between the two groups.

Conclusion

Laparoscopic surgery for colorectal cancer is a safe and feasible option with better short-term outcomes in patients with sarcopenia.

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Funding

This work was funded by the National Natural Science Foundation of China (Nos. 81800795, 81770884), Shanghai Municipal Commission of Health and Family Planning (No. 20184Y0301), Shanghai Science and Technology Committee (No. 16411954200), the Fundamental Research Funds for the Central Universities and the foundation of the Health Department of Zhejiang province (2016DTA006).

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Correspondence to Cheng-Le Zhuang.

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Feng-Min Zhang, Bing-Wei Ma, Yang-Yang Huang, Wei-Zhe Chen, Jing-Juan Chen, Qian-Tong Dong, Wei-Sheng Chen, Xiao-Lei Chen, Xian Shen, Zhen Yu, and Cheng-Le Zhuang have no conflicts of interest or financial ties to disclose.

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Zhang, FM., Ma, BW., Huang, YY. et al. Laparoscopic colorectal cancer surgery reduces the adverse impacts of sarcopenia on postoperative outcomes: a propensity score-matched analysis. Surg Endosc 34, 4582–4592 (2020). https://doi.org/10.1007/s00464-019-07249-0

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Keywords

  • Sarcopenia
  • Laparoscopy
  • Colorectal cancer
  • Short-term outcome
  • Propensity score