Relationship between computed tomography-derived body composition, sex, and post-operative complications in patients with colorectal cancer

Arwa S Almasaudi, Ross D Dolan, Stephen T McSorley, Paul G Horgan, Christine Edwards, Donald C McMillan
European Journal of Clinical Nutrition 2019, 73 (11): 1450-1457

INTRODUCTION: In the UK, colorectal cancer is the fourth most common cancer and the second most common cause of cancer death. Surgery is the primary modality of treatment, but it is not without complications. Post-operative complications have been linked to preoperative of weight loss and loss of lean tissue, and also to obesity. Given sex differences in body composition, an examination of body composition and post-operative complications may provide valuable information. Therefore, the aim was to examine the relationship between male/female body composition and post-operative complications in patients with operable colorectal cancer.

METHODS: Patients (n = 741) undergoing operation for colorectal cancer were examined. Preoperative CT scans were used to define the muscle mass and quality, visceral obesity, and subcutaneous adiposity. Post-operative complications, in particular, surgical site infection (SSI) and wound infection (WI) were considered as outcome measures.

RESULTS: Male patients with greater subcutaneous adiposity had higher risk of SSI and WI (p < 0.01 and p ≤ 0.001, respectively). On multivariate analysis, Post-operative Glasgow Prognostic Score (poGPS) on Day 4 (OR 2.11, 95% CI 1.53-2.92, P = 0.001) laparoscopic surgery (OR 0.50, 95% CI 0.26-0.98, P = 0.044), and subcutaneous adiposity (OR 2.71, 95% CI 1.26-5.82, P = 0.011) remained significantly independently associated with overall SSI. Subcutaneous adiposity remained significantly independently associated with WI (OR 3.93, 95% CI 1.33-11.57, P = 0.013). In female patients, however, no significant association was found between any body composition measure and complications.

CONCLUSION: This study showed that increased subcutaneous and visceral adiposity were associated with infective complications in male, but not female patients, after colorectal cancer surgery. Therefore, it is important that sex be taken into account when evaluating the potential impact of body composition on post-operative outcomes in patients undergoing surgery for colorectal cancer.

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