Cited by 139Nutrition and Health in AgingColorectal Cancer Surgical TreatmentsBody Composition Measurement Techniques

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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

Martin, Lisa, Hopkins, Jessica, Malietzis, Georgios, Jenkins, J. T., Sawyer, Michael B., Brisebois, Ron, MacLean, Anthony, Nelson, Gregg, Gramlich, Leah, Baracos, Vickie E.·2018·Annals of Surgical Oncology

DOI 10.1245/s10434-018-6652-x

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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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Piloting a training program in computed tomography skeletal muscle assessment for registered dietitians
Martin, L., Tom, M., Basualdo‐Hammond, C., Baracos, V. E., & Gramlich, L. M. (2022) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.2348 · Cited by 17
Myosteatotic and sarcopenic obesity impact postoperative outcomes more robustly than visceral obesity in general surgery patients, with differences by sex
Jones, A., & Silver, H. J. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.03.005 · Cited by 17
Diagnosis and prevalence of sarcopenic obesity in patients with colorectal cancer: A scoping review
Saino, Y., Kawase, F., Nagano, A., Ueshima, J., Kobayashi, H., Murotani, K., Inoue, T., Nagami, S., Suzuki, M., & Maeda, K. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.025 · Cited by 16
A Cross-Sectional Validation Study of Camry EH101 versus JAMAR Plus Handheld Dynamometers in Colorectal Cancer Patients and Their Correlations with Bioelectrical Impedance and Nutritional Status
Jiménez‐Sánchez, A., Cunill, J. L. P., Limón-Mirón, M. L., López-Ladrón, A., Bofill, J. S., & García‐Luna, P. P. (2024) · Nutrients · doi:10.3390/nu16121824 · Cited by 17
“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.”
Background
Cancer cachexia and treatment toxicity
Chowdhry, S. M., & Chowdhry, V. K. (2019) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000450 · Cited by 16
Protein for the Pre-Surgical Cancer Patient: a Narrative Review
Gillis, C., & Phillips, S. M. (2021) · Current anesthesiology reports · doi:10.1007/s40140-021-00494-x · Cited by 15
Physical and Psychological Health Behavior Changes During the COVID-19 Pandemic that May Inform Surgical Prehabilitation: a Narrative Review
Silver, J. K., Mina, D. S., Bates, A. S., Gillis, C., Silver, E. M., Hunter, T. L., & Jack, S. (2022) · Current anesthesiology reports · doi:10.1007/s40140-022-00520-6 · Cited by 16
Excess visceral fat area as an independent risk factor for early postoperative complications in patients with obesity undergoing bariatric surgery
Han, L., Deng, C., Zhao, R., Wan, Q., Zhang, X., Wang, X., & Chen, Y. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1072540 · Cited by 14
Call for standardization in assessment and reporting of muscle and adipose change using computed tomography analysis in oncology: A scoping review
Klassen, P. N., Mazurak, V. C., Thorlakson, J. J. D., & Servais, S. (2023) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13318 · Cited by 13
The association between sarcopenia and quality of life in patients undergoing colorectal cancer surgery: an exploratory study
Besson, A. J., Deftereos, I., Gough, K., Taylor, D., Shannon, R., & Yeung, J. M. C. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06025-y · Cited by 14
A novel tissue inhibitor of metalloproteinases‐1/liver/cachexia score predicts prognosis of gastrointestinal cancer patients
Prokopchuk, O., Hermann, C. D., Schoeps, B., Nitsche, U., Prokopchuk, O. L., Knolle, P. A., Friess, H., Martignoni, M. E., & Krüger, A. (2021) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.12680 · Cited by 12
“3 as described elsewhere.(21,22) Total adipose tissue (TAT) was calculated by summing up the surface area of VAT, SAT, and IMAT.”
Method
Tumor metabolic activity is associated with subcutaneous adipose tissue radiodensity and survival in non-small cell lung cancer
Sun, Y., Deng, M., Gevaert, O., Aberle, M. R., Damink, S. W. M. O., van Dijk, D. P. J., & Rensen, S. S. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.05.040 · Cited by 12
Muscle matters: Prognostic implications of malnutrition and muscle health parameters in patients with cancer. A secondary analysis of a randomised trial
Olpe, T., Wunderle, C., Bargetzi, L., Tribolet, P., Laviano, A., Stanga, Z. G., Prado, C. M. M., Müeller, B., & Schüetz, P. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.07.020 · Cited by 12
Tumour grade and stage are associated with specific body composition phenotypes with visceral obesity predisposing the host to a less aggressive tumour in colorectal cancer
Pring, E. T., Malietzis, G. A., Gould, L. E., Lung, P. F. C., Drami, I., Athanasiou, T., & Jenkins, J. T. (2022) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2022.03.012 · Cited by 13
How reliably can ultrasound help determine muscle and adipose tissue thickness in clinical settings? An assessment of intra- and inter-examiner reliability in the USVALID study
Fischer, A., Hahn, R., Anwar, M., Hertwig, A., Pesta, M., Timmermann, I., Siebenrock, T., Liebau, K., Brugger, J., Posch, M., et al. (2021) · European Journal of Clinical Nutrition · doi:10.1038/s41430-021-00955-w · Cited by 11
CT-based muscle and adipose measurements predict prognosis in patients with digestive system malignancy
Zheng, K., Liu, X.-L., Li, Y.-G., Cui, J., & Li, W. (2024) · Scientific Reports · doi:10.1038/s41598-024-63806-1 · Cited by 9
“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 .”
Method
N1c colon cancer and the use of adjuvant chemotherapy: a current audit of the National Cancer Database
Simon, H. L., de Paula, T. R., Spigel, Z. A., & Keller, D. S. (2020) · Colorectal Disease · doi:10.1111/codi.15406 · Cited by 11
Visceral obesity enhances inflammatory response after laparoscopic colorectal resection
Conti, C., Pedrazzani, C., Turri, G., Gecchele, G., Valdegamberi, A., Ruzzenente, A., Zamboni, G. A., Lippi, G., & Guglielmi, A. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14795 · Cited by 11
The impact of obesity and morbid obesity on urgent/emergency colorectal resections: a regional database analysis
Choi, D., Hendren, S. K., Chang, M. I., Abunayla, A., Battaglia, M. A., & Cleary, R. K. (2021) · Surgical Endoscopy · doi:10.1007/s00464-021-08467-1 · Cited by 10
“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].”
Background
Perioperative 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
Thigh muscle by CT images as a predictor of mortality in patients with newly diagnosed colorectal cancer
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
Sarcopenia is independently associated with poor preoperative physical fitness in patients undergoing colorectal cancer surgery
Rai, J., Pring, E. T., Knight, K. A., Tilney, H. S., Gudgeon, J., Gudgeon, M., Taylor, F., Gould, L. E., Wong, J., Andreani, S. M., et al. (2024) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13536 · Cited by 8
Prognostic Impact of Sarcopenic Obesity on Postoperative Outcomes in Colorectal Cancer Patients Undergoing Surgery: A Systematic Review and Meta-Analysis
Kopuz, T. N. Y., Yıldız, H. F., Er, S., & Fisunoğlu, M. (2025) · Nutrition and Cancer · doi:10.1080/01635581.2025.2450843 · Cited by 8
“…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%.”
Influential
Myosteatosis: A Distinct, Early and Targetable Novel Biomarker of Cancer Prognosis
Kumar, N. B. (2026) · Cancers · doi:10.3390/cancers18060974 · Cited by 8
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
“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.”
BackgroundInfluential
A 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
Use of computed tomography for the diagnosis of surgical sarcopenia: Review of recent research advances
Xiao, Y., Xiao‐yue, Z., Yue, W., Ruo‐tao, L., Xiang‐jie, L., Xing‐yuan, W., Wang, Q., Xiao‐hua, Q., & Jia, Z. (2022) · Nutrition in Clinical Practice · doi:10.1002/ncp.10847 · Cited by 7
Prevalence of Low Muscle Mass in the Computed Tomography at the Third Lumbar Vertebra Level Depends on Chosen Cut-Off in 200 Hospitalised Patients—A Prospective Observational Trial
Fischer, A., Kiss, N., Rudas, V.-A., Nieding, K., Veraar, C., Timmermann, I., Liebau, K., Pesta, M., Siebenrock, T., Anwar, M., et al. (2022) · Nutrients · doi:10.3390/nu14163446 · Cited by 7
“Cut-off values given for different age groups decreased with higher age [10,16].”
BackgroundMethodInfluential
Prehabilitation
Minnella, E. M., Gillis, C., Edgar, L., & Carli, F. (2020) · Springer eBooks · doi:10.1007/978-3-030-33443-7_10 · Cited by 7
Novel multimodal intervention for surgical prehabilitation on functional recovery and muscle characteristics in patients with non-small cell lung cancer: study protocol for a randomised controlled trial (MMP-LUNG)
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
A Cross-Sectional Validation of Horos and CoreSlicer Software Programs for Body Composition Analysis in Abdominal Computed Tomography Scans in Colorectal Cancer Patients
Jiménez‐Sánchez, A., Soriano-Redondo, M. E., Cunill, J. L. P., Martínez-Ortega, A. J., Rodríguez-Mowbray, J. R., Solís, I. M. R., & García‐Luna, P. P. (2024) · Diagnostics · doi:10.3390/diagnostics14151696 · Cited by 5
“…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].”
Background
Sarcopenia 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
Evaluation of sarcopenia biomarkers in older patients undergoing major surgery for digestive cancer. SAXO prospective cohort study
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
Deep Learning-Based Body Composition Analysis for Cancer Patients Using Computed Tomographic Imaging
Potter, İ. Y., Hammerle, M. V. V., Nazarian, A., & Vaziri, A. (2024) · Journal of Imaging Informatics in Medicine · doi:10.1007/s10278-024-01373-7 · Cited by 5
Perioperative Optimization of Patient Nutritional Status
Holubar, S. D., & Soop, M. (2020) · Springer eBooks · doi:10.1007/978-3-030-33443-7_6 · Cited by 4
High protein diet in digestive cancers
Laviano, A. (2022) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000857 · Cited by 4
Prognostic impact of myosteatosis on postoperative outcomes and survival in colorectal cancer: a systematic review
Han, C., Zhang, J., Kokelaar, R., Wei, M. Y.-K., & Yeung, J. M. (2026) · International Journal of Colorectal Disease · doi:10.1007/s00384-025-05061-y · Cited by 3
“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].”
The effect of myopenia, myosteatosis and visceral obesity on postoperative complications and inflammation in colorectal surgery
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
Sarcopenia in colorectal cancer is related to socio-economic deprivation and Body Mass Index alone misrepresents underlying muscle loss in the deprived
Pring, E. T., Gould, L. E., Malietzis, G. A., Lung, P. F. C., Mai, D. V. C., Drami, I., Athanasiou, T., & Jenkins, J. T. (2024) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2024.06.005 · Cited by 3
Bacterial biomarkers: new aspects of colorectal tumors diagnosis: reality or fantasy
Shahbazi, T., Bakhshi, B., Fazeli, M. S., & Derakhshan-Nezhad, E. (2023) · European Journal of Cancer Prevention · doi:10.1097/cej.0000000000000760 · Cited by 3
Association between body composition phenotypes and treatment toxicity in women with cervical cancer undergoing chemoradiotherapy.
Aredes, M., de Paula, N. S. D., & Chaves, G. V. (2024) · Nutrition (Burbank, Los Angeles County, Calif.) · doi:10.1016/j.nut.2024.112539 · Cited by 2
Skeletal muscle density as a new predictor of abdominal infection in abdominal trauma patients
Xi, F., Zheng, N., Xiong, B., Wang, D., Teng, R., Zhang, X., Zhang, T., Wei, C., Wang, X., & Tan, S. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.10.035 · Cited by 3
Influence of Muscle Mass Area and Visceral Obesity on 30-day Mortality After Colorectal Surgery with Primary Anastomosis
Moctezuma-Velázquez, P., Vergara-Fernández, O., Salgado-Nesme, N., Aguilar-Frasco, J. L., Sainz-Hernández, J. C., & Moctezuma-Velázquez, C. (2021) · Revista de investigaci�n Cl�nica · doi:10.24875/ric.21000108 · Cited by 3
Sarcopenia in Metastatic Colorectal Carcinoma
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Prognostic Value of Body Fat Density in Colorectal Cancer Adjuvant Treatment: A Retrospective Cohort Study
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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).”
Multimodal Prehabilitation In Pancreatic cancer Patients undergoing surgery (PIPS): study protocol for a randomized controlled trial
Pecorelli, N., Fermi, F., Abati, M., Bonomi, B., Fossati, L., Corti, G., Guarneri, G., Macchini, M., Damascelli, A., Palumbo, D., et al. (2026) · Trials · doi:10.1186/s13063-026-09467-z · Cited by 2
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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: Martin, Lisa
Hopkins, Jessica
Jenkins, J. T.
Sawyer, Michael B.
MacLean, Anthony
Nelson, Gregg
Gramlich, Leah
Baracos, Vickie E.
Venue: Annals of Surgical Oncology
Publisher: Springer Science and Business Media LLC
Published: 2018-07-13
Volume: 25
Issue: 9
Pages: 2669-2680
ISSN: 1068-9265 (ISSN-L)
1534-4681
DOI: 10.1245/s10434-018-6652-x
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 (medical) › Nutrition and Health in Aging
Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
Health Sciences › Medicine › Physiology (medical) › 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

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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

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