Impact of Muscle Mass Depletion on Surgical Outcomes in Patients with Primary High-grade Serous Ovarian Cancer Undergoing CRS and HIPEC

• Published in: Journal of the College of Physicians and Surgeons--Pakistan Vol. 31; no. 11; pp. 1314 - 1319
• Main Authors: Mercan, Umit, Gulpinar, Basak, Ersen, Ogun, Kosmaz, Koray, Durhan, Abdullah, Unal, Ali Ekrem
• Format: Journal Article
• Language: English
• Published: College of Physicians and Surgeons Pakistan 01-11-2021
• Subjects: Care and treatment; Complications and side effects; Hyperthermic intraperitoneal chemotherapy; Ovarian cancer; Patient outcomes; Prognosis; Sarcopenia; Turkey
• ISSN: 1022-386X; 1681-7168
• DOI: 10.29271/jcpsp.2021.11.1314

Objective: To investigate the effect of sarcopenia on surgical outcomes in patients with primary high-grade serous ovarian cancer undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC). Study Design: Descriptive study. Place and Duration of Study: Department of Surgical Oncology, Faculty of Medicine, Ankara University Ankara, Turkey, from January 2013 to January 2020. Methodology: Forty patients, who underwent CRS and HIPEC with the diagnosis of primary high-grade serous ovarian cancer and peritoneal carcinomatosis were included in the study. Preoperative staging CT images were used to determine total psoas index values by measuring psoas muscle area at the level of L3 vertebra. Patients with total psoas index values below the cutoff levels were considered sarcopenic. Demographic, clinicopathological and perioperative results were compared between sarcopenic and non-sarcopenic patients. Results: Serious postoperative complications (36.4% vs. 6.9%, p=0.039) and infective (54.5% vs. 17.2%, p=0.042) and pulmonary (72.7% vs. 34.5%, p=0.040 complications were significantly higher in sarcopenic patients. Hospital stay [20(12-25) vs. 12(9-16.5) days, p=0.017] and ICU stay [4(2-6) vs. 2(1-2.5) days, p=0.013)] were found to be longer in sarcopenic patients. In univariate analysis, advanced age (OR: 1.40 95% CI: 1.07-1.84; p=0.021) and sarcopenia (OR: 7.71% 95 CI: 1.17- 51.06; p=0.039) were significantly associated with serious postoperative complications. The presence of sarcopenia (OR: 0.050 95% CI: 0.004-0.675; p=0.024) was found to be independent predictor of serious postoperative complications. Conclusion: Sarcopenia can easily be diagnosed without additional cost or radiation exposure with routine preoperative staging CT images. Identification of sarcopenic ovarian cancer patients in preoperative period may affect patient selection, predictability of possible serious complications, elective operation preparation process with a combination of nutrition and exercise therapy, thus postoperative complication rates may be reduced and short-term results may be improved. Key Words: Cytoreductive surgery, Ovarian cancer, Sarcopenia.