Risk stratification in surgical oncology: the role of radiological sarcopenia
Risk stratification in surgical oncology: the role of radiological sarcopenia
This thesis of Linda Weerink examines postoperative outcomes in cancer patients, with particular emphasis on the role of radiological sarcopenia in preoperative risk assessment. In older cancer patients (severe) postoperative complications are associated with significantly worse survival. This makes it all the more important to inform patients on the chance that they will experience complications and associated functional decline following a surgical procedure. The more vulnerable or frail patients are, the greater their chance of complications. Frailty can be measured using different screening tools, this thesis examines if muscle mass evaluated on CT-scans (radiological sarcopenia) could be used to predict outcome following surgery. Both low muscle mass and low muscle density are valuable in identifying vulnerable patients, although they should not be used interchangeably in risk assessments. Low psoas (deep muscle in the back) mass is a stronger predictor of severe postoperative complications and 30-day mortality than low total skeletal muscle mass. The combined presence of radiological sarcopenia and frailty is associated with significantly decreased survival.
Although CT-imaging remains the gold standard for assessing muscle mass, bioelectrical impedance analysis and mid-arm-muscle-circumference can serve as practical screening tools for low muscle mass, especially when CT-imaging is unavailable. The presence of radiological sarcopenia before surgery is not related to recovery of physical activity after surgery, underscoring the complexity of predicting postoperative recovery based on a single risk factor and the importance of a broadly oriented preoperative screening assessing different aspects of frailty. Radiological parameters, such as the presence of radiological sarcopenia, can provide additional information to existing screening tools.