The psoas muscle density as a predictor of postoperative complications in elderly patients undergoing rectal cancer resection
Yunzhou Xiao, Xiaoting Wen, Yingying Ying, Xiaoyan Zhang, Luyao Li, Zhongchu Wang, Miaoguang Su, Xiangwu Zheng, Shouliang Miao
Abstract
Background Muscle depletion that impairs normal physiological function in elderly patients leads to poor prognosis. This study aimed to evaluate the association between total abdominal muscle area (TAMA), total psoas area (TPA), psoas muscle density (PMD), and short-term postoperative complications in elderly patients with rectal cancer. Methods All elderly patients underwent rectal cancer resection with perioperative abdominal computed tomography (CT). Complications were assessed according to the Clavien-Dindo classification. Severe complications were defined as grade III-V following the Clavien-Dindo classification. Univariate and multivariate analyses were performed to evaluate risk factors of short-term severe postoperative complications. Results The cohort consisted of 191 patients with a mean age of 73.60 ± 8.81 years. Among them, 138 (72.25%) patients had Clavien-Dindo 0- II, 53 (27.75%) patients had severe postoperative complications (Clavien-Dindo III-V), and 1(0.52%) patient died within 30 days of surgery. PMD was significantly higher in the Clavien-Dindo 0-II cohort compared to the Clavien-Dindo III-V cohort ( p =0.004). Nevertheless, TAMA and TPA failed to exhibit significant differences. Moreover, the multivariate regression analysis implied that advanced age [OR 1.07 95%CI (1.02–1.13) p =0.013], male [OR 5.03 95%CI (1.76-14.41) p =0.003], high charlson comorbidity index (CCI) score [OR 3.60 95%CI (1.44-9.00) p =0.006], and low PMD [OR 0.94 95%CI (0.88-0.99) p =0.04] were independent risk factors of Clavien-Dindo III-V. Conclusion Preoperative assessment of the PMD on CT can be a simple and practical method for identifying elderly patients with rectal cancer at risk for severe postoperative complications.