Annals of Surgical Oncology

, Volume 25, Issue 9, pp 2669–2680 | Cite as

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

  • Lisa Martin
  • Jessica Hopkins
  • Georgios Malietzis
  • J. T. Jenkins
  • Michael B. Sawyer
  • Ron Brisebois
  • Anthony MacLean
  • Gregg Nelson
  • Leah Gramlich
  • Vickie E. BaracosEmail author
Gastrointestinal Oncology



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.


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.


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.


The findings showed that CT-defined multidimensional body habitus is independently associated with LOS and hospital readmission.



Funding for Lisa Martin was provided by the Izaak Walton Killam Memorial Scholarship, an Alberta Innovates Health Solutions Graduate Research Studentship, and a C. Richard Fleming Grant from the ASPEN Rhoads Research Foundation. Project funding was provided by the Alberta Innovates Health Solutions Partnership for Research and Innovation in the Health System Grant and Alberta Health Services Cancer Strategic Clinical Network.



Supplementary material

10434_2018_6652_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 31 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Lisa Martin
    • 1
  • Jessica Hopkins
    • 2
    • 3
  • Georgios Malietzis
    • 4
    • 5
  • J. T. Jenkins
    • 4
    • 5
  • Michael B. Sawyer
    • 3
  • Ron Brisebois
    • 2
  • Anthony MacLean
    • 6
  • Gregg Nelson
    • 7
  • Leah Gramlich
    • 8
  • Vickie E. Baracos
    • 3
    Email author
  1. 1.Department of Agricultural, Food and Nutritional ScienceUniversity of AlbertaEdmontonCanada
  2. 2.Department of SurgeryUniversity of AlbertaEdmontonCanada
  3. 3.Department of Oncology, 4023 Cross Cancer InstituteUniversity of AlbertaEdmontonCanada
  4. 4.Department of SurgerySt. Mark’s HospitalHarrow, LondonUK
  5. 5.Department of Surgery and CancerImperial CollegeLondonUK
  6. 6.Department of SurgeryUniversity of CalgaryCalgaryCanada
  7. 7.Department of OncologyUniversity of CalgaryCalgaryCanada
  8. 8.Department of MedicineUniversity of AlbertaEdmontonCanada

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