Clinical Impact of Preoperative Sarcopenia on the Outcome of Patients With Right-Sided Colon Cancer

Abstract

Introduction

Sarcopenia is recognized as a predictor of adverse outcomes in colorectal cancer, but evidence regarding its impact specifically in right-sided colon cancer remains limited. This study aimed to evaluate the prognostic significance of sarcopenia in patients undergoing colectomy for right-sided colon cancer.

Methods

We retrospectively analyzed 228 patients with right-sided colon adenocarcinoma who underwent curative-intent colectomy between 2016 and 2021 in a single institution. Sarcopenia was diagnosed using the psoas muscle index (PMI) on preoperative CT scans. Clinicopathologic variables, postoperative complications, overall survival (OS), and disease-free survival (DFS) were compared between sarcopenic and non-sarcopenic groups.

Results

Among sarcopenic patients (34.2%), postoperative complications occurred in 46.2% compared with 23.3% of non-sarcopenic patients (P < .001). Sarcopenia was significantly associated with intra-abdominal infection (P = 0.040), pulmonary infection (P = .011), cardiac complications (P = .013), urinary tract infection (P = .013), and postoperative hypoalbuminemia (P < .022). Logistic regression identified postoperative hypoalbuminemia (P = .026) and prolonged hospital stay (P = .002) as independent predictors of complications. The 5-year OS was 19.7% in sarcopenic patients vs 43.0% in non-sarcopenic patients (P = .597), and 5-year DFS was 43.1% vs 51.7% (P = .154). Multivariate Cox analysis identified age ≥65 years (P = .015), male sex (P = .007), stage IV disease (P = .016), and elevated CEA (P = .021) as independent predictors of OS, and age ≥65 years (P = .046) and stage IV disease (P = .001) as independent predictors of DFS, while sarcopenia was not an independent predictor of either outcome.

Conclusion

Sarcopenia was strongly associated with postoperative complications but not with OS or DFS. These findings suggest sarcopenia reflects perioperative risk rather than long-term prognosis in this subgroup.