Page 104 - Risk quantification and modification in older patients with colorectal cancer

Chapter 5
as an important target for interventions such as prehabilitation for improving outcomes.33
There are some limitations to our study. First, the incidence of severe complications such as anastomotic leakage was low. By stratifying patients based in quartiles, the number of events in each outcome of interest was further reduced. Second, we did not have data on the number of patients that were considered unsuitable for surgery, which may have induced a selection bias.
Despite these limitations, we think that our results are representative. Strengths of this study are that a relatively large older cohort of patients was included, with prospectively collected data with standardised quality. The low interrater variability indicates that our skeletal muscle mass and muscle density analysis is robust.
To increase clinical applicability of muscle mass and density measurements for older cancer patients, larger cohort studies are needed that also include measurement of muscle strength and physical performance, in accordance with the updated guidelines on sarcopenia.10 Also, the use of a mobility aid as derivative of physical performance and other frailty parameters included in a geriatric assessment, such as cognitive functioning, are also of interest in association with poor surgical outcome.
Conclusion
Low skeletal muscle density and not muscle mass might be associated with more complications after colorectal surgery in older patients with non-metastatic cancer. Physical performance has the strongest association for poor surgical outcome, including OS and should be investigated when measuring skeletal muscle mass and density.
102