サルコペニアと大腸がん術後の感染・回復遅延

サルコペニアは大腸がん術後の感染と回復遅延と関連するという論文を紹介します。

Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012 Aug 7. doi: 10.1038/bjc.2012.350.

サルコペニアの評価は術前のCTで行っています。結果ですが、38.9％にサルコペニアを認めました。感染は16.7％、入院リハ施設への転院（＝回復遅延）は9％でした。サルコペニアを認めた患者は、入院期間が長く、特に65歳以上の高齢者で長かったです。

感染リスク、入院リハ施設への転院とも、サルコペニアを認める患者で多く、特に65歳以上の高齢者に多いという結果でした。65歳以上の高齢者の多変量解析でもサルコペニアは感染リスク、入院リハ施設への転院の独立した危険因子でした。

以上よりサルコペニアは術後感染、入院リハ施設転院、長い入院期間を予測するという結論です。これは臨床的にうなづける結果です。次はやはりPrehabilitationで術後感染、入院リハ施設への転院、入院期間を改善できるかどうかの検証が重要ですね。

Abstract

Background:Skeletal muscle depletion (sarcopenia) predicts morbidity and mortality in the elderly and cancer patients.Methods:We tested whether sarcopenia predicts primary colorectal cancer resection outcomes in stage II-IV patients (n=234). Sarcopenia was assessed using preoperative computed tomography images. Administrative hospitalisation data encompassing the index surgical admission, direct transfers for inpatient rehabilitation care and hospital re-admissions within 30 days was searched for International Classification of Disease (ICD)-10 codes for postoperative infections and inpatient rehabilitation care and used to calculate length of stay (LOS).Results:Overall, 38.9% were sarcopenic; 16.7% had an infection and 9.0% had inpatient rehabilitation care. Length of stay was longer for sarcopenic patients overall (15.9±14.2 days vs 12.3±9.8 days, P=0.038) and especially in those 65 years (20.2±16.9 days vs 13.1±8.3 days, P=0.008). Infection risk was greater for sarcopenic patients overall (23.7% vs 12.5%; P=0.025), and especially those 65 years (29.6% vs 8.8%, P=0.005). Most (90%) inpatient rehabilitation care was in patients 65 years. Inpatient rehabilitation was more common in sarcopenic patients overall (14.3% vs 5.6%; P=0.024) and those 65 years (24.1% vs 10.7%, P=0.06). In a multivariate model in patients 65 years, sarcopenia was an independent predictor of both infection (odds ratio (OR) 4.6, (95% confidence interval (CI) 1.5, 13.9) P<0 .01=".01" 1.04="1.04" 3.1="3.1" 9.4="9.4" a="a" and="and" care="care" ci="ci" consequently="consequently" infections="infections" inpatient="inpatient" longer="longer" los.="los." onclusion:sarcopenia="onclusion:sarcopenia" p="p" postoperative="postoperative" predicts="predicts" rehabilitation="rehabilitation">