ERAS in Colorectal Surgery Diminishes the Negative Impact of Sarcopenia on Short Term Outcomes

Study Overview
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Brief Summary
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So far, the impact of sarcopenia has been analysed only in patients undergoing traditional surgical procedures (laparotomy) or those with metastatic spread. As the ERAS protocol combined with minimally invasive access decreases postoperative metabolic disorders, it seems possible that it can limit the deleterious impact of sarcopenia as well. The aim of this study was to investigate whether the use of ERAS protocol in colorectal cancer patients influences the postoperative risk due to sarcopenia.

Detailed Description
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The prospective observation with post-hoc analysis of 171 consecutive colorectal cancer patients was performed. In all patients 16-item ERAS protocol was applied. Contrast-enhanced CT scan was performed preoperatively. From each scan one CT image at the level of L3 vertebra was transferred in Digital Imaging and Communications in Medicine format (DICOM) and anonymised. Firstly, the threshold range between -29 and +150 Hounsfield units was set to semi-automatically outline muscle areas, - 150 to - 50 was used for visceral adipose tissue areas, and -190 to -30 was used for subcutaneous and intermuscular adipose tissue areas. Secondly, the software calculated the surface area (cm2) of each tissue. The L3 skeletal muscle area (rectus abdominis, external and internal obliques, transversus abdominis, quadratus lumborum, psoas, erector spinae) normalized for patient height was used to calculate skeletal muscle index (SMI) (cm2/m2). According to Martin et al. sarcopenia was defined as a SMI <41 cm2/m2 in women, <43 cm2/m2 in men with a BMI <25 kg/m2, and <53 cm2/m2 in men with a BMI >25 kg/m2 (10). To assess for myosteatosis the mean radiodensity of a L3 psoas muscle was measured. The cut-off for patients with BMI <25 kg/m2 was <41 Hounsfield units and <33 Hounsfield units for patients with BMI ≥25 kg/m2. For the purposes of further analysis the entire group of patients was divided into subgroups depending on the presence of sarcopenia or myosteatosis.

Official Title
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Enhanced Recovery After Surgery Protocol (ERAS) in Colorectal Surgery Diminishes the Negative Impact of Sarcopenia on Short Term Outcomes

Conditions
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Sarcopenia, Colonic Neoplasms

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: confirmed adenocarcinoma of colon or rectum complete preoperative radiology assessment with abdominal CT scan laparoscopic resection perioperative care according to ERAS principles Exclusion Criteria: unavailability of a preoperative abdominal CT scan (within 30 days prior surgery) emergency or initially open surgery patients treated with endoscopic techniques: transanal endoscopic microsurgery (TEM), transanal total mesorectal excision (TaTME) concomitant inflammatory bowel diseases.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group 1<br>not sarcopenic | |
| Group 2<br>sarcopenic | |
| Group 3<br>not myosteatotic | |
| Group 4<br>myosteatotic | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complications |  | up to 30 days post surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital length of stay (days) |  | up to discharge from hospital, an average 6 days | 
| Compliance with ERAS protocol (%) |  | up to discharge from hospital, an average 6 days | 
| Tolerance of oral diet on the 1st postoperative day | tolerating at least 800 ml of clear water/fluids and 1 oral nutritional supplement within the first 24h postoperative hours | up to discharge from hospital, an average 6 days | 
| Time to first flatus |  | up to discharge from hospital, an average 6 days | 
| Readmission rate |  | up to 30 days post surgery | 
| Mobilization on the 1st postoperative day | walking at least 100 m without assistance, at least 6h out of bed (sitting, walking) | up to discharge from hospital, an average 6 days | 
| Need for opioid analgesia postoperatively | no need for opioid drug administration (any kind, dosage or administration route) | up to discharge from hospital, an average 6 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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sarcopenia, myosteatosis, enhanced recovery after surgery, colorectal cancer, minimally invasive surgery, complications