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Composição corporal na cirurgia colorretal eletiva do programa Enhanced Recovery After Surgery®
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Introdução: O cancro colorretal (CCR) é o mais comum em Portugal. A cirurgia, considerada o tratamento primário da doença não metastizada, desencadeia uma resposta ao stress, onde o programa Enhanced Recovery After Surgery® (ERAS®) foca-se na otimização dos resultados cirúrgicos. A sarcopénia, mioesteatose e obesidade visceral, definidos por Tomografia Computorizada (TC), têm sido associadas a maior morbilidade e mortalidade, em doentes cirúrgicos e oncológicos, mas são poucos os estudos em doentes ERAS® com CCR. Objetivo: Estudar a associação de perfis de composição corporal (sarcopénia, mioesteatose e obesidade visceral) com as complicações pós-operatórias dos doentes ERAS® submetidos a cirurgia colorretal. Metodologia: Estudo retrospetivo, com inclusão de 232 doentes ERAS® de cirurgia colorretal. Na análise das imagens TC pré-operatória, por intervalos de Hounsfield Units, obteve-se dados de diferentes tecidos e classificou-se os doentes com sarcopénia, mioesteatose e obesidade visceral. A análise estatística permitiu investigar a influência destes perfis e de outros parâmetros na taxa de complicações pós-operatórias. Resultados: O estudo mostrou uma prevalência de 39% de sarcopénia, 61% de mioesteatose e 70% de obesidade visceral e, 23% dos três perfis, no pré-operatório. Mioesteatose, tecido adiposo intramuscular (TAIM) elevado, risco anestésico (American Society of Anesthesiology) elevado, compliance baixa e cirurgia aberta estavam associados a maior risco de complicações pós-operatórias (p<0.05). Não foram encontradas associações com sarcopénia (p=0.322) ou obesidade visceral (p=0.068). Na análise multivariada, TAIM mostrou ser fator preditivo independente de complicações pós-operatórias (OR, 1.059; IC 95%, 1.031-1.092; p<0.001) e, compliance (OR, 0.902; IC 95%, 0.858-0.946; p<0.001) e laparoscopia (OR, 0.455; IC 95%, 0.246-0.837; p=0.016) fatores protetores independentes. Conclusão: Existe uma grande prevalência destes perfis de composição corporal, associados a um pior desfecho pós-operatório, em doentes ERAS® submetidos a cirurgia colorretal, na população estudada. A identificação de mioesteatose deve ser considerada no pré-operatório, pois pode representar um fator de risco modificável.
Introduction: Colorectal cancer (CRC) is the most common cancer in Portugal. Surgery, considered the primary treatment of non-metastatic disease, triggers a stress response, where the Enhanced Recovery After Surgery® (ERAS®) program aims the optimization of surgical outcomes. Computed tomography (CT)-defined sarcopenia, myosteatosis and visceral obesity have been associated with increased morbidity and mortality rates in surgical and cancer patients, but there are few studies in ERAS® patients with CRC. Aim: To study the association of body composition profiles (sarcopenia, myosteatosis and visceral obesity) with postoperative complications of ERAS® patients undergoing colorectal surgery. Methodology: Retrospective study, including 232 ERAS® patients undergoing colorectal surgery. In the analysis of preoperative CT images, with Hounsfield Units (HU) intervals, data from different tissues were obtained and patients were classified with sarcopenia, myosteatosis and visceral obesity. Statistical analyses allowed to investigate the influence of these body composition profiles and other parameters on the rate of postoperative complications. Results: The study showed a prevalence of 39% of sarcopenia, 61% of myosteatosis and 70% of visceral obesity and, 23% of the three profiles, preoperatively. Myosteatosis, high intramuscular adipose tissue (IMAT), high anesthetic risk (American Society of Anesthesiology), low compliance and open surgery were associated with a higher risk of postoperative complications (p<0.05). No associations with sarcopenia (p=0.322) or visceral obesity (p=0.067) were found. In the multivariate analysis, IMAT showed to be an independent predictive factor of postoperative complications (OR, 1.059; 95% CI, 1.031-1.092; p<0.001) and, compliance (OR, 0.902; 95% CI, 0.858-0.946; p<0.001) and laparoscopy (OR, 0.455; 95% CI, 0.246-0.837; p=0.016) independent protective factors. Conclusion: There is a high prevalence of body composition profiles associated with a worse postoperative outcome in ERAS® patients undergoing colorectal surgery, in the studied population. Identification of myosteatosis should be considered in the preoperative period, as it may represent a modifiable risk factor.
Introduction: Colorectal cancer (CRC) is the most common cancer in Portugal. Surgery, considered the primary treatment of non-metastatic disease, triggers a stress response, where the Enhanced Recovery After Surgery® (ERAS®) program aims the optimization of surgical outcomes. Computed tomography (CT)-defined sarcopenia, myosteatosis and visceral obesity have been associated with increased morbidity and mortality rates in surgical and cancer patients, but there are few studies in ERAS® patients with CRC. Aim: To study the association of body composition profiles (sarcopenia, myosteatosis and visceral obesity) with postoperative complications of ERAS® patients undergoing colorectal surgery. Methodology: Retrospective study, including 232 ERAS® patients undergoing colorectal surgery. In the analysis of preoperative CT images, with Hounsfield Units (HU) intervals, data from different tissues were obtained and patients were classified with sarcopenia, myosteatosis and visceral obesity. Statistical analyses allowed to investigate the influence of these body composition profiles and other parameters on the rate of postoperative complications. Results: The study showed a prevalence of 39% of sarcopenia, 61% of myosteatosis and 70% of visceral obesity and, 23% of the three profiles, preoperatively. Myosteatosis, high intramuscular adipose tissue (IMAT), high anesthetic risk (American Society of Anesthesiology), low compliance and open surgery were associated with a higher risk of postoperative complications (p<0.05). No associations with sarcopenia (p=0.322) or visceral obesity (p=0.067) were found. In the multivariate analysis, IMAT showed to be an independent predictive factor of postoperative complications (OR, 1.059; 95% CI, 1.031-1.092; p<0.001) and, compliance (OR, 0.902; 95% CI, 0.858-0.946; p<0.001) and laparoscopy (OR, 0.455; 95% CI, 0.246-0.837; p=0.016) independent protective factors. Conclusion: There is a high prevalence of body composition profiles associated with a worse postoperative outcome in ERAS® patients undergoing colorectal surgery, in the studied population. Identification of myosteatosis should be considered in the preoperative period, as it may represent a modifiable risk factor.
Descrição
Tese de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2021
Palavras-chave
Cirurgia cancro colorretal Programa ERAS® Complicações pós-operatórias Composição corporal Tomografia computadorizada Teses de mestrado - 2021