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Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis

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Abstract

Purpose

Previous studies have shown an association of sarcopenia with adverse short- and long-term outcomes in multiple gastrointestinal cancer types. We aimed to investigate the prognostic value of sarcopenia on the postoperative outcomes and survival rates of patients with colorectal cancer (CRC).

Methods

A systematic literature search was performed using the PubMed, Embase, Cochrane, Google Scholar, and Scopus databases. We included studies that compared postoperative outcomes or survival rates in sarcopenic and non-sarcopenic patients with CRC.

Results

A total of 44 observational studies, comprising 18,891 patients, were included. The pooled prevalence of sarcopenia was 37% (n = 7009). The pooled analysis revealed an association between sarcopenia and higher risk of total postoperative complications (23 studies, OR = 1.84; 95% CI 1.35–2.49), postoperative severe complications (OR = 1.72; 95% CI 1.10–2.68), postoperative mortality (OR = 3.21; 95% CI 2.01–5.11), postoperative infections (OR = 1.40; 95% CI 1.12–1.76), postoperative cardiopulmonary complications (OR = 2.92; 95% CI 1.96–4.37), and prolonged length of stay (MD = 0.77; 95% CI 0.44–1.11) after colorectal cancer surgery. However, anastomotic leakage showed comparable occurrence between sarcopenic and non-sarcopenic patients (OR = 0.99; 95% CI 0.72 to 1.36). Regarding survival outcomes, sarcopenic patients had significantly shorter overall survival (25 studies, HR = 1.83; 95% CI = 1.57–2.14), disease-free survival (HR = 1.55; 95% CI = 1.29–1.88), and cancer-specific survival (HR = 1.77; 95% CI 1.40–2.23) as compared with non-sarcopenic patients.

Conclusion

Among patients with colorectal cancer, sarcopenia is a strong predictor of increased postoperative complications and worse survival outcomes.

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Data availability

All data is available upon request.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan, 4800, Mexico City, Mexico

    Mario Trejo-Avila

  2. Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Mexico City, Mexico

    Katya Bozada-Gutiérrez, Carlos Valenzuela-Salazar, Jesús Herrera-Esquivel & Mucio Moreno-Portillo

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  1. Mario Trejo-Avila
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Contributions

Mario Trejo-Avila: study conception design, data acquisition, data analysis, data interpretation, drafting the article, overall supervision, critical revision, and final approval.

Katya Bozada-Gutiérrez: data acquisition, data interpretation, drafting the article, overall supervision, critical revision, and final approval.

Carlos Valenzuela-Salazar: data acquisition and interpretation, drafting the article, overall supervision, critical revision, and final approval.

José Herrera-Esquivel: data acquisition and interpretation, drafting the article, overall supervision, critical revision, and final approval.

Mucio Moreno-Portillo: data acquisition and analysis, data interpretation, drafting the article, overall supervision, critical revision, and final approval.

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Correspondence to Mario Trejo-Avila.

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Trejo-Avila, M., Bozada-Gutiérrez, K., Valenzuela-Salazar, C. et al. Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 36, 1077–1096 (2021). https://doi.org/10.1007/s00384-021-03839-4

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