Assessment of computed tomography (CT)-defined muscle and adipose tissue features in relation to short-term outcomes after elective surgery for colorectal cancer: a multicenter approach
Abstract
Background Sarcopenia, visceral obesity (VO), and reduced muscle radiodensity (myosteatosis) are suggested risk factors for postoperative morbidity in colorectal cancer (CRC), but usually are not concurrently assessed. Published thresholds used to define these features are not CRC-specific and are defined in relation to mortality, not postoperative outcomes. This study aimed to evaluate body composition in relation to length of hospital stay (LOS) and postoperative outcomes.Methods Pre-surgical computed tomography (CT) images were assessed for total area and radiodensity of skeletal muscle and visceral adipose tissue in a pooled Canadian and UK cohort (n = 2100). Sex- and age-specific values for these features were calculated. For 1139 of 2100 patients, LOS data were available, and sex- and age-specific thresholds for sarcopenia, myosteatosis, and VO were defined on the basis of LOS. Association of CT-defined features with LOS and readmissions was explored using negative binomial and logistic regression models, respectively.Results In the multivariable analysis, the predictors of LOS (P < 0.001) were age, surgical approach, major complications (incidence rate ratio [IRR] 2.42; 95% confidence interval [CI] 2.18-2.68), study cohort, and three body composition profiles characterized by myosteatosis combined with either sarcopenia (IRR, 1.27; 95% CI 1.12-1.43) or VO (IRR, 1.25; 95% CI 1.10-1.42), and myosteatosis combined with both sarcopenia and VO (IRR, 1.58; 95% CI 1.29-1.93). In the multivariable analysis, risk of readmission was associated with VO alone (odds ratio [OR] 2.66; 95% CI 1.18-6.00); P = 0.018), VO combined with myosteatosis (OR, 2.72; 95% CI 1.36-5.46; P = 0.005), or VO combined with myosteatosis and sarcopenia (OR, 2.98; 95% CI 1.06-5.46; P = 0.038). Importantly, the effect of body composition profiles on LOS and readmission was independent of major complications.Conclusion The findings showed that CT-defined multidimensional body habitus is independently associated with LOS and hospital readmission.
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Patients with higher levels of myosteatosis in colorectal cancer demonstrated longer hospitalizations compared to those with lower levels.
“Patients with higher levels of myosteatosis in colorectal cancer also demonstrated longer hospitalizations compared to those with lower levels (Martin et al., 2018).”
From Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging (2020) · cites this paper as Martin et al., 2018
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Significance of Acquisition Parameters for Adipose Tissue Segmentation on CT Images
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“The same counts for VAT or visceral obesity, which was found to be associated with postoperative complications [36, 45–48], LOS [36, 46, 48], readmission [49], and 2-year survival [50] in some studies.”
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“Well-differentiated LS 18 [13] 2 [6] 16 [15]”
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“based on associations with post-operative length of stay in a large cohort of CRC patients undergoing surgery [17].”
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Sarcopenic obesity and therapeutic outcomes in gastrointestinal surgical oncology: A meta-analysis
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Preoperative Muscle Strength Is a Predictor of Outcomes After Esophagectomy
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“43,45 Seven studies analysed overall complications; due to different cut-off points, pooling of data was not possible.”
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“interpretation is difficult, and the clinical application of these measurements is controversial.(13,21,22) This study aims to determine the influence of CT-measured body composition parameters and their combination on non-metastatic CRC long-term outcomes.”
BackgroundDemystifying Malnutrition to Improve Nutrition Screening and Assessment in Oncology
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Skeletal muscle radiodensity and cancer outcomes: A scoping review of the literature
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Diagnosis and prevalence of sarcopenic obesity in patients with colorectal cancer: A scoping review
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“MM loss acts as an independent predictor of survival [3,4]; physical, cognitive, and social functioning [5,6]; health-related quality of life [7]; postoperative complications and hospital length of stay [8,9]; and dose-limiting toxicity from capecitabine and bevacizumab [10] in colorectal cancer.”
BackgroundCancer cachexia and treatment toxicity
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Protein for the Pre-Surgical Cancer Patient: a Narrative Review
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“3 as described elsewhere.(21,22) Total adipose tissue (TAT) was calculated by summing up the surface area of VAT, SAT, and IMAT.”
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“SFA, VFA and TFA were normalized for height 2 and reported as SFA index (SFAI, cm 2 /m 2 ), VFA index (VFAI, cm 2 /m 2 ) and TFA index (TFAI, cm 2 /m 2 ) 17 .”
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Visceral obesity enhances inflammatory response after laparoscopic colorectal resection
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“Although many studies apply BMI to categorize obesity, others have suggested that CT-defined visceral obesity and sarcopenia may better characterize obesity risk [19, 20].”
BackgroundPerioperative Nutritional Considerations in Colon and Rectal Surgery
Curran, T. (2023) · Clinics in Colon and Rectal Surgery · doi:10.1055/s-0043-1761152 · Cited by 9 · see citing works
Ferreira, G. M. C., Pereira, J. P. D. C., Miranda, A. L., de Medeiros, G. O. C., Bennemann, N. A., Alves, V. A., Costa, E. C., Verde, S. M. M. L., Chaves, G. V., Murad, L. B., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-68008-3 · Cited by 9 · see citing works
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“…defined as the coexistence of sarcopenia and obesity in 13 studies (3, 16, 18, 23–31, 34 ) , and as an In the eighteen studies (3, 4, 12, 16–18, 23–27, 29, 30, 32–36) that provided data on the number of sar-copenic obese individuals, the prevalence of sarcope-nic obesity ranged from 0.4% to 59.3%.”
InfluentialMyosteatosis: A Distinct, Early and Targetable Novel Biomarker of Cancer Prognosis
Kumar, N. B. (2026) · Cancers · doi:10.3390/cancers18060974 · Cited by 8 · see citing works
Impact of CT-measured sarcopenic obesity on postoperative outcomes following colon cancer surgery
Bajawi, M., Corral, S. G., Blázquez, J., Trill, J. D., Muñoz, P., Barranquero, A. G., Juez, L. D., & García‐Moreno, F. (2024) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-024-03231-0 · Cited by 8 · see citing works
“The association between SO and immediate postoperative mortality was evident [5.07 (1.22–20.93); p = 0.03], aligning with its link to abdominal complications and, specifically, anastomotic leak, the latter being a leading cause of postoperative mortality in our cohort.”
BackgroundInfluentialA survey of preoperative surgical nutrition practices, opinions, and barriers across Canada
Bellafronte, N. T., Nasser, R., Gramlich, L. M., Carli, F., Liberman, A. S., Mina, D. S., Schierbeck, G., Ljungqvist, O. H., & Gillis, C. (2024) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2023-0195 · Cited by 7 · see citing works
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“Cut-off values given for different age groups decreased with higher age [10,16].”
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Moyen, A., Fleurent-Grégoire, C., Gillis, C., Zaks, R., Carli, F., Scheede‐Bergdahl, C., Spicer, J. D., Cools‐Lartigue, J., Najmeh, S., Morais, J. A., et al. (2025) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2024-002884 · Cited by 5 · see citing works
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“…an independent predictor of events of interest such as survival [1,13–17]; physical, cognitive and social functionality [18,19]; quality of life [20]; postoperative complications [21]; length of hospital stay [22,23]; and the need for in-hospital rehabilitation or discharge to a nursing home [24].”
BackgroundSarcopenia as a Prognostic Factor for the Outcomes of Surgical Treatment of Colorectal Carcinoma
Leščák, Š., Košíková, M., & Jenčová, S. (2025) · Healthcare · doi:10.3390/healthcare13070726 · Cited by 5 · see citing works
Gagnat, G., Hobeika, C., Modzelewski, R., Collet, C. S., Fiore, F. D., Druesne, L., Tuech, J., & Schwarz, L. (2022) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2022.08.038 · Cited by 5 · see citing works
Deep Learning-Based Body Composition Analysis for Cancer Patients Using Computed Tomographic Imaging
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Perioperative Optimization of Patient Nutritional Status
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High protein diet in digestive cancers
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“Ten studies investigated the association between myosteato-sis and length of stay (LoS) in colorectal cancer, with four good quality studies identified [18–20, 23, 37, 40, 42, 45, 50, 51].”
Vaes, S., Peters, E. G., Nors, J., Back, C. H., Leclercq, W., Reilingh, T. S. D. V., Luyer, M. D. P., & Smeets, B. J. J. (2026) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2026.102934 · Cited by 3 · see citing works
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Bacterial biomarkers: new aspects of colorectal tumors diagnosis: reality or fantasy
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Skeletal muscle density as a new predictor of abdominal infection in abdominal trauma patients
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Sarcopenia in Metastatic Colorectal Carcinoma
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“Previous studies have demonstrated the relationship between fat distribution and lean body mass as prognostic indicators of post-operative complications, hospital stay, and mortality (4,12,20).”
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- Authors
- Martin, L., Hopkins, J., Malietzis, G., Jenkins, J. T., Sawyer, M. B., Brisebois, R., MacLean, A., Nelson, G., Gramlich, L., & Baracos, V. E.
- Affiliations
- University of Alberta (CA)
- St Mark's Hospital (GB)
- University of Calgary (CA)
- Corresponding author
- Baracos, Vickie E.
- ORCID
- Venue
- Annals of Surgical Oncology
- Published
- 2018-07-13
- Volume
- 25
- Issue
- 9
- Pages
- 2669-2680
- ISSN
- 1068-9265 (ISSN-L)
- 1534-4681
- OpenAlex
- W2884255416
- Cited by
- 139
- References
- 59
- Citations by year
- 2026: 17 · 2025: 11 · 2024: 20 · 2023: 10 · 2022: 24 · 2021: 23 · 2020: 22 · 2019: 11 · 2018: 1
- FWCI
- 9.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Annals of Surgical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Alberta Innovates - Health Solutions (Partnership for Research, Innovation in the Hea)
- Alberta Health Services (Cancer Strategic Clinical Network Seed Grant)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- colorectal cancer, sarcopenia, visceral obesity, myosteatosis, body composition, skeletal muscle radiodensity, visceral adipose tissue, length of hospital stay, postoperative complications, hospital readmission, elective colorectal surgery, preoperative risk assessment, surgical approach, major postoperative complications, risk stratification, prognostic factors
- MeSH terms
- Adipose Tissue, Aged, Body Composition, Female, Follow-Up Studies, Humans, Male, Patient Readmission, Postoperative Complications, Prognosis, Risk Factors, Tomography, X-Ray Computed, Colorectal Neoplasms, Cohort Studies, Survival Rate, Elective Surgical Procedures, Muscle, Skeletal, Sarcopenia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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