Colorectal cancer that has spread to the peritoneum: can muscle mass predict treatment complications?

This study examined whether skeletal muscle mass could be used to predict complications in colorectal cancer patients undergoing treatment for cancer that has spread to the peritoneum (the lining of the abdomen).

Metastatic colorectal cancer indicates that the cancer has spread from the colon or rectum to another organ or tissue. A common location for the cancer to spread to is the peritoneal surface. The best treatment for patients with peritoneal metastasis is cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CS/HIPEC). CS/HIPEC involves surgically removing affected parts of the peritoneum and then bathing the abdominal cavity in heated chemotherapy.

Unfortunately, CS/HIPEC is associated with a high risk of complications. Being able to predict which patients are more likely to develop complications would help determine which patients will benefit from the treatment. Skeletal muscle loss (sarcopenia) has been linked to complications after colorectal cancer surgery. It is not known whether muscle mass measurements can also be used to predict complications after CS/HIPEC.

This study examined the medical records of 206 colorectal cancer patients who were treated with CS/HIPEC. Imaging technology (computed tomography scan) was used to measure the skeletal muscle mass before surgery. The muscle mass measurements were used to classify patients as having sarcopenia or not.

Overall, 43.7% of patients were classified as having sarcopenia. Patients with sarcopenia were significantly more likely to need more than one operation (25.6% of patients) compared to patients who did not have sarcopenia (12.1% of patients).

There was a higher rate of complications in the patients with sarcopenia (54.4%), compared to those without sarcopenia (41.4%). There was also a higher rate of severe complications in the group with sarcopenia (33.3%), compared to the group without sarcopenia (21.6%).

The authors concluded that decreased muscle mass was associated with an increased risk of severe complications after CS/HIPEC. They suggest that measuring muscle mass could be useful for assessing patients risk before surgery.

This was a retrospective study (results are based on medical records) which may limit the value of the results as it increases the potential for bias.