Is sarcopenia really a risk factor in the development of postoperative complications?

This study was aimed to evaluate the impact of sarcopenia, which was defined by total psoas area (TPA) and total psoas volume (TPV) measurements, on the development of major postoperative complications.

Sarcopenia was assessed in 225 patients with gastrointestinal cancer who underwent surgery between October 2015 and March 2020. The impact of sarcopenia defined by TPA and TPV on major postoperative complications was assessed using multivariate analysis.

Both the median TPA and TPV were higher in men than that in women (p < 0.001). The cut-off value of TPA to define sarcopenia was 526.5 mm²/m² and 495.68 mm²/m² for men and women, respectively, and the cut-off value of TPV was 79.6 cm³/m² for men and 83.1 cm³/m² for women, While 102 patients (45.3%) had sarcopenia defined by TPA, 54 (24%) had sarcopenia defined by TPV. Seventy-eight patients had at least one complication; 36 (46%) had major complications, and 15 patients died during the study. In logistic regression analysis, only sex was found as a risk factor for the development of sarcopenia (OR = 13.403, p = 0.014). There was a positive correlation between TPA and TPV in male and female patients separately (r = 0.841 and r = 0.883, respectively, p < 0.001). Only sarcopenia defined by TPV was found as a risk factor for the development of major postoperative complication (OR: 35.349, p = 0.028).

Sarcopenia defined by TPV is an independent risk factor in predicting major postoperative complications, not TPA. We believe that volume measurement instead of area is a more accurate method for evaluating sarcopenia in gastrointestinal cancer surgery.