Composição corporal como fator prognóstico de eventos adversos em pacientes cirúrgicos com câncer gástrico e colorretal: um estudo observacional

Abstract

Cancer is one of the leading causes of death worldwide, with gastric and colorectal tumors among the 10 most common types. Changes in body composition and skeletal muscle mass of cancer patients are common; however, such changes may directly impact survival and are associated with a higher incidence of postsurgical complications. The aim of this study was to evaluate which aspects related to body composition, muscle strength and skeletal muscle characteristics are predictive factors of postoperative complications in patients with gastric and colorectal cancer. A prospective study, from December 2017 to December 2018, was performed with surgical patients with gastric and colorectal cancer. Computed tomography images of the abdominal region were evaluated to determine body composition: amount of skeletal muscle through Skeletal Muscle Index (SMI), skeletal muscle quality through muscle radiodensity, which reflects fat infiltration into the muscle, and amount of Visceral Adipose Tissue. Sarcopenia was defined as low SMI, and myosteatosis as low muscle radiodensity. Dynapenia was defined as low handgrip strength. Grade II post-surgical complications or above, according to Clavien-Dindo's classification, were considered in this study. All patients were followed up until hospital discharge, and 30 days after discharge. A total of 84 patients were included in the study and 17.9% were diagnosed with sarcopenia, 16.7% with myosteatosis and 31% with dynapenia. Post-surgical complications occurred in 51.2% of the sample. Cox regression analyze showed that dynapenia combined with sarcopenia and/or myosteatosis was the strongest independent predictor of risk for postoperative complications in patients with gastric and colorectal cancer. In conclusion, it is strongly recommended to evaluate the body composition before performing the surgical procedure, which may help to screen patients at higher risk of developing complications, reducing the risks from this therapeutic modality.