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Impact of combined resection of the internal iliac artery on loss of volume of the gluteus muscles after pelvic exenteration

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Abstract

Purpose

To clarify the influence of additional internal iliac artery (IIA) resection on the loss of the gluteus muscle volume after pelvic exenteration (PE).

Methods

The subjects of this retrospective analysis were 78 patients who underwent PE with or without IIA resection (n = 44 and n = 34, respectively) between 2006 and 2018. The areas of gluteal muscles (GMs) and psoas muscles (PSMs) were calculated using CT images before and 6 months after PE, and the difference was compared.

Results

The volumes of the GMs and PSMs were significantly reduced after PE (P < 0.001 and P = 0.005, respectively). In the IIA resection group, the GMs were significantly reduced after surgery, but the PSMs were not. The maximum GM (Gmax) was the most atrophied among the GMs. Multivariable analysis revealed that complete IIA resection was an independent promotor of the loss of volume of the Gmax (P = 0.044). In 18 patients with unilateral IIA resection, the downsizing rate of the Gmax was significantly greater on the resected side than on the non-resected side (P = 0.008).

Conclusions

The GMs and PSMs were significantly smaller after PE. Complete IIA resection reduced the Gmax area remarkably. Preservation of the superior gluteus artery is likely to help maintain Gmax size, suggesting a potential preventative measure against secondary sarcopenia.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on resonable request.

References

  1. Nielsen MB, Rasmussen PC, Lindegaard JC, Laurberg S. A 10-year experience of total pelvic exenteration for primary advanced and locally recurrent rectal cancer based on a prospective database. Colorectal Dis. 2012;14:1076–83.

    Article  CAS  PubMed  Google Scholar 

  2. Ferenschild FT, Vermaas M, Verhoef C, Ansink AC, Kirkels WJ, Eggermont AMM, et al. Total pelvic exenteration for primary and recurrent malignancies. World J Surg. 2009;33:1502–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Harji DP, Griffiths B, Velikova G, Sagar PM, Brown J. Systematic review of health-related quality of life in patients undergoing pelvic exenteration. Eur J Surg Oncol. 2016;42:1132–45.

    Article  CAS  PubMed  Google Scholar 

  4. Rausa E, Kelly ME, Bonavina L, O’Connell PR, Winter DC. A systematic review examining quality of life following pelvic exenteration for locally advanced and recurrent rectal cancer. Colorectal Dis. 2017;19:430–6.

    Article  CAS  PubMed  Google Scholar 

  5. Coker DJ, Koh CE, Steffens D, Young JM, Vuong K, Alchin L, et al. The affect of personality traits and decision-making style on postoperative quality of life and distress in patients undergoing pelvic exenteration. Colorectal Dis. 2020;22:1139–46.

    Article  CAS  PubMed  Google Scholar 

  6. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010;39:412–23.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci. 2014;69:547–58.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian working group for sarcopenia. J Am Med Dir Assoc. 2014;15:95–101.

    Article  PubMed  Google Scholar 

  9. Shachar SS, Williams GR, Muss HB, Nishijima TF. Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer. 2016;57:58–67.

    Article  PubMed  Google Scholar 

  10. Choi Y, Oh DY, Kim TY, Lee KH, Han SW, Im SA, et al. Skeletal muscle depletion predicts the prognosis of patients with advanced pancreatic cancer undergoing palliative chemotherapy, independent of body mass index. PLoS ONE. 2015;10: e0139749. https://doi.org/10.1371/journal.pone.0139749.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Tan BH, Brammer K, Randhawa N, Welch NT, Parsons SL, James EJ, et al. Sarcopenia is associated with toxicity in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer. Eur J Surg Oncol. 2015;41:333–8.

    Article  CAS  PubMed  Google Scholar 

  12. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012;107:931–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Levolger S, van Vugt JL, de Bruin RW, IJ JN. Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies. Br J Surg. 2015;102:1448–58.

    Article  CAS  PubMed  Google Scholar 

  14. Kuroki LM, Mangano M, Allsworth JE, Menias CO, Massad LS, Powell MA, et al. Pre-operative assessment of muscle mass to predict surgical complications and prognosis in patients with endometrial cancer. Ann Surg Oncol. 2015;22:972–9.

    Article  CAS  PubMed  Google Scholar 

  15. Otsuji H, Yokoyama Y, Ebata T, Igami T, Sugawara G, Mizuno T, et al. Surgery-related muscle loss and its association with postoperative complications after major hepatectomy with extrahepatic bile duct resection. World J Surg. 2017;41:498–507.

    Article  PubMed  Google Scholar 

  16. Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33:997–1006.

    Article  PubMed  Google Scholar 

  17. Macadam P, Cronin J, Contreras B. An examination of the gluteal muscle activity associated with dynamic hip abduction and hip external rotation exercise: a systematic review. Int J Sports Phys Ther. 2015;10:573–91.

    PubMed  PubMed Central  Google Scholar 

  18. Macadam P, Feser EH. Examination of gluteus maximus electromyographic excitation associated with dynamic hip extension during body weight exercise: a systematic review. Int J Sports Phys Ther. 2019;14:14–31.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bordoni B, Varacallo M. Anatomy, bony pelvis and lower limb, iliopsoas muscle. Treasure Island (FL): StatPearls Publishing; 2021.

    Google Scholar 

  20. Gaudric J, Tresson P, Derycke L, Du Tezenas MS, Couture T, Davaine JM, et al. Surgical internal iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms to avoid buttock claudication and distal type I endoleaks. J Vasc Surg. 2018;68:1736–43.

    Article  PubMed  Google Scholar 

  21. Bosanquet DC, Wilcox C, Whitehurst L, Cox A, Williams IM, Twine CP. Systematic review and meta-analysis of the effect of internal iliac artery exclusion for patients undergoing EVAR. Eur J Vasc Endovasc Surg. 2017;53:534–48.

    Article  CAS  PubMed  Google Scholar 

  22. Uehara K, Ito Z, Yoshino Y, Arimoto A, Kato T, Nakamura H, et al. Aggressive surgical treatment with bony pelvic resection for locally recurrent rectal cancer. Eur J Surg Oncol. 2015;41:413–20.

    Article  CAS  PubMed  Google Scholar 

  23. Uehara K, Nakamura H, Yoshino Y, Arimoto A, Kato T, Yokoyama Y, et al. Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery. Surg Endosc. 2016;30:132–8.

    Article  PubMed  Google Scholar 

  24. Tanaka A, Uehara K, Aiba T, Ogura A, Mukai T, Yokoyama Y, et al. The role of surgery for locally recurrent and second recurrent rectal cancer with metastatic disease. Surg Oncol. 2020;35:328–35.

    Article  PubMed  Google Scholar 

  25. Kudou K, Saeki H, Nakashima Y, Sasaki S, Jogo T, Hirose K, et al. Postoperative development of sarcopenia is a strong predictor of a poor prognosis in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer. Am J Surg. 2019;217:757–63.

    Article  PubMed  Google Scholar 

  26. Kobayashi A, Kaido T, Hamaguchi Y, Okumura S, Taura K, Hatano E, et al. Impact of postoperative changes in sarcopenic factors on outcomes after hepatectomy for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci. 2016;23:57–64.

    Article  PubMed  Google Scholar 

  27. van Ramshorst GH, Young JM, Solomon MJ. Complications and impact on quality of life of vertical rectus abdominis myocutaneous flaps for reconstruction in pelvic exenteration surgery. Dis Colon Rectum. 2020;63:1225–33.

    Article  PubMed  Google Scholar 

  28. Hori Y, Nishii T, Kono AK, Ohta Y, Inoue Y, Omura A, et al. Does endovascular abdominal aortic repair change psoas muscle volume? Ann Vasc Surg. 2020;63:162–9.

    Article  PubMed  Google Scholar 

  29. Kurose S, Matsubara Y, Yoshino S, Nakayama K, Yamashita S, Morisaki K, et al. Influence of internal iliac artery embolization during endovascular aortic repair regarding postoperative sarcopenia and midterm survival. Ann Vasc Surg. 2020;74:148–57.

    Article  PubMed  Google Scholar 

  30. Lopez MJ, Luna-Pérez P. Composite pelvic exenteration: is it worthwhile? Ann Surg Oncol. 2004;11:27–33.

    Article  PubMed  Google Scholar 

  31. Austin KK, Herd AJ, Solomon MJ, Ly K, Lee PJ. Outcomes of pelvic exenteration with en bloc partial or complete pubic bone excision for locally advanced primary or recurrent pelvic cancer. Dis Colon Rectum. 2016;59:831–5.

    Article  PubMed  Google Scholar 

  32. Added MAN, de Freitas DG, Kasawara KT, Martin RL, Fukuda TY. Strengthening the gluteus maximus in subjects with sacroiliac dysfunction. Int J Sports Phys Ther. 2018;13:114–20.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Distefano LJ, Blackburn JT, Marshall SW, Padua DA. Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther. 2009;39:532–40.

    Article  PubMed  Google Scholar 

  34. Liang SS, Ying AJ, Affan ET, Kakala BF, Strippoli GF, Bullingham A, et al. Continuous local anaesthetic wound infusion for postoperative pain after midline laparotomy for colorectal resection in adults. Cochrane Database Syst Rev. 2019;10:CD012310. https://doi.org/10.1002/14651858.CD012310.pub2.

    Article  PubMed  Google Scholar 

  35. Beck DE, Margolin DA, Babin SF, Russo CT. Benefits of a multimodal regimen for postsurgical pain management in colorectal surgery. Ochsner J. 2015;15:408–12.

    PubMed  PubMed Central  Google Scholar 

  36. Bartlett JL, Sumner B, Ellis RG, Kram R. Activity and functions of the human gluteal muscles in walking, running, sprinting, and climbing. Am J Phys Anthropol. 2014;153:124–31.

    Article  PubMed  Google Scholar 

  37. Zacharias A, Pizzari T, Semciw AI, English DJ, Kapakoulakis T, Green RA. Comparison of gluteus medius and minimus activity during gait in people with hip osteoarthritis and matched controls. Scand J Med Sci Sports. 2019;29:696–705.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yuki Murata, Kay Uehara, Atsushi Ogura, Toshisada Aiba, Takashi Mizuno, Toshio Kokuryo, Yukihiro Yokoyama & Tomoki Ebata

  2. Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Satoko Ishigaki

  3. Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Hiroshi Yatsuya

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  1. Yuki Murata
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  2. Kay Uehara
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  3. Atsushi Ogura
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  4. Satoko Ishigaki
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  5. Toshisada Aiba
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  6. Takashi Mizuno
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Contributions

Study conception and design: YM, KU, and AO. Acquisition of data: YM, SI, TA, TM, and TK. Analysis and interpretation of data: YM, KU, AO, SI, YY, and HY. Drafting of manuscript: YM and KU. Critical revision of manuscript: YM, KU, and TE.

Corresponding author

Correspondence to Kay Uehara.

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We have no competing interests to declare.

Ethical approval

This retrospective study was approved by the Nagoya University Hospital Institutional Review Board (#2020-0105).

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Murata, Y., Uehara, K., Ogura, A. et al. Impact of combined resection of the internal iliac artery on loss of volume of the gluteus muscles after pelvic exenteration. Surg Today 53, 791–799 (2023). https://doi.org/10.1007/s00595-022-02635-z

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  • DOI: https://doi.org/10.1007/s00595-022-02635-z

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