Computed tomography‐based preoperative muscle measurements as prognostic factors for anastomotic leakage following oncological sigmoid and rectal resections

Journal of Surgical Oncology, vol. 127, pp. 823–830

Abstract

Abstract Background Oncological sigmoid and rectal resections are accompanied with substantial risk of anastomotic leakage. Preoperative risk assessment and patient selection remain difficult, highlighting the importance of finding easy‐to‐use parameters. This study evaluates the prognostic value of contrast‐enhanced (CE) computed tomography (CT)‐based muscle measurements for predicting anastomotic leakage. Methods Patients that underwent oncological sigmoid and rectal resections in the LUMC between 2016 and 2020 were included. Preoperative CE‐CT scans, were analyzed using Vitrea software to measure total abdominal muscle area (TAMA) and total psoas area (TPA). Muscle areas were standardized using patient's height into: psoas muscle index (PMI) and skeletal muscle index (SMI) (cm 2 /m 2 ). Results In total 46 patients were included, of which 13 (8.9%) suffered from anastomotic leakage. Patients with anastomotic leakage had a significantly lower PMI (22.1 vs. 25.1, p < 0.01) and SMI (41.8 vs. 46.6, p < 0.01). After adjusting for confounders (age and comorbidity), lower PMI (odds ratio [OR]: 0.85, 95% confidence interval [CI] 0.71–0.99, p = 0.03) and SMI (OR: 0.93, 95%CI 0.86–0.99, p = 0.02) were both associated with anastomotic leakage. Conclusion This study showed that lower PMI and SMI were associated with anastomotic leakage. These results indicate that preoperative CT‐based muscle measurements can be used as prognostic factor for risk stratification for anastomotic leakage.

Authors 10

1. Robert T. van Kooten corresponding Aachen Department of Surgery Leiden University Medical Center Leiden the Netherlands Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Leiden University Medical Center Leiden The Netherlands

   Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

2. Cor J. Ravensbergen Aachen Department of Surgery Leiden University Medical Center Leiden the Netherlands Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Leiden University Medical Center Leiden The Netherlands

   Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

3. Sophie C. D. van Büseck Aachen Department of Surgery Leiden University Medical Center Leiden the Netherlands Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Leiden University Medical Center Leiden The Netherlands

   Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

4. Willem Grootjans Aachen Department of Radiology Leiden University Medical Center Leiden The Netherlands Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology Leiden University Medical Center Leiden The Netherlands

   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

5. Koen C.M.J. Peeters Aachen Department of Surgery Leiden University Medical Center Leiden the Netherlands Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Leiden University Medical Center Leiden The Netherlands

   Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

6. Fabian A. Holman Aachen Department of Surgery Leiden University Medical Center Leiden the Netherlands Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Leiden University Medical Center Leiden The Netherlands

   Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

7. Jan W T Heemskerk Aachen Department of Radiology Leiden University Medical Center Leiden The Netherlands Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology Leiden University Medical Center Leiden The Netherlands

   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

8. Michel W.J.M. Wouters Aachen Department of Biomedical Data Sciences Leiden University Medical Center Leiden The Netherlands Department of Biomedical Data Sciences

   Leiden University Medical Center · The Netherlands Cancer Institute

   Affiliation as printed

   Department of Biomedical Data Sciences Leiden University Medical Center Leiden The Netherlands

   Department of Surgery Netherlands Cancer Institute‐Antoni van Leeuwenhoek Amsterdam The Netherlands

   Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands

   Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands

9. Ana Navas Cañete Aachen Department of Radiology Leiden University Medical Center Leiden The Netherlands Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology Leiden University Medical Center Leiden The Netherlands

   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

10. Rob A.�E.�M. Tollenaar Aachen Department of Surgery Leiden University Medical Center Leiden the Netherlands Department of Surgery, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Surgery Leiden University Medical Center Leiden The Netherlands

    Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands