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Patient Psoas Muscle Mass as a Predictor of Complications and Survival After Radical Cystectomy

  • Urothelial Cancer (A Sagalowsky, Section Editor)
  • Published:
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Abstract

As a treatment for high-risk bladder cancer, radical cystectomy (RC) remains a highly morbid operation with complication rates of 40–60 % and mortality rates as high as 9 % in the first 90 days after surgery (Aziz et al., Eur Urol 66(1):156–163, 2014; Shabsigh et al., Eur Urol 55(1):164–174, 2009). Many patients suffer from a failure-to-thrive syndrome associated with anorexia, weight loss, dehydration, and immobility. In elderly patients, failure-to-thrive may result in loss of independence and a cascade of events that increases the risk of perioperative morbidity and mortality, ultimately resulting in impaired survival. Psoas muscle mass has been used to predict morbidity and mortality after major surgical procedures in vulnerable populations with substantial comorbidities. Increasingly, psoas muscle mass is also being used to predict outcomes after RC. If patients with a high risk of impaired survival are identified preoperatively, prehabilitative interventions can be integrated into their preparation for surgical treatment (Porserud et al., Clin Rehab 28(5):451–459, 2014; Friedman et al., Nutr Clin Pract: Off Publ Am Soc Parenter Enter Nutr 30(2):175–179, 2015). This chapter discusses the role of psoas muscle mass as a predictor of negative surgical outcomes after cystectomy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147(8):755–63.

    Article  CAS  PubMed  Google Scholar 

  2. Welle S, Brooks AI, Delehanty JM, Needler N, Thornton CA. Gene expression profile of aging in human muscle. Physiol Genomics. 2003;14(2):149–59.

    Article  CAS  PubMed  Google Scholar 

  3. Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Singh MA. Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. Am J Clin Nutr. 2002;76(2):473–81.

    CAS  PubMed  Google Scholar 

  4. Morley JE. Hormones and the aging process. J Am Geriatr Soc. 2003;51(7 Suppl):S333–7.

    Article  PubMed  Google Scholar 

  5. Park SW, Goodpaster BH, Lee JS, Kuller LH, Boudreau R, de Rekeneire N, et al. Excessive loss of skeletal muscle mass in older adults with type 2 diabetes. Diabetes Care. 2009;32(11):1993–7.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Katsanos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. Aging is associated with diminished accretion of muscle proteins after the ingestion of a small bolus of essential amino acids. Am J Clin Nutr. 2005;82(5):1065–73.

    CAS  PubMed  Google Scholar 

  7. Visser M, Deeg DJ, Lips P. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab. 2003;88(12):5766–72.

    Article  CAS  PubMed  Google Scholar 

  8. Ferrucci L, Penninx BW, Volpato S, Harris TB, Bandeen-Roche K, Balfour J, et al. Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. J Am Geriatr Soc. 2002;50(12):1947–54.

    Article  PubMed  Google Scholar 

  9. International Working Group on S. Sarcopenia: An Undiagnosed Condition in Older Adults. Current consensus definition: prevalence, etiology, and consequences. J Am Med Dir Assoc. 2011;12(4):249–56. This article defines sarcopenia, provides guidelines for assessment, and briefly describes its prevalence, etiology, and consequences.

    Article  Google Scholar 

  10. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    Article  CAS  PubMed  Google Scholar 

  12. Bauer JM, Sieber CC. Sarcopenia and frailty: a clinician’s controversial point of view. Exp Gerontol. 2008;43(7):674–8.

    Article  CAS  PubMed  Google Scholar 

  13. Lee JS, He K, Harbaugh CM, Schaubel DE, Sonnenday CJ, Wang SC, et al. Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair. J Vasc Surg. 2011;53(4):912–7.

    Article  PubMed  Google Scholar 

  14. Englesbe MJ, Patel SP, He K, Lynch RJ, Schaubel DE, Harbaugh C, et al. Sarcopenia and mortality after liver transplantation. J Am Coll Surg. 2010;211(2):271–8.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Hasselager R, Gogenur I. Core muscle size assessed by perioperative abdominal CT scan is related to mortality, postoperative complications, and hospitalization after major abdominal surgery: a systematic review. Langenbecks Arch Surg. 2014;399(3):287–95. This paper reviews the literature where core muscle size measurements have been used for risk assessment of patients undergoing major abdominal surgery. Specifically, they describe associations between sarcopenia and surgical outcomes such as mortality, postoperative complications, and readmission.

    Article  PubMed  Google Scholar 

  16. Sheetz KH, Waits SA, Terjimanian MN, Sullivan J, Campbell DA, Wang SC, et al. Cost of major surgery in the sarcopenic patient. J Am Coll Surg. 2013;217(5):813–8. The authors used data from the Michigan Surgical Quality Collaborative to characterize the independent financial impact of sarcopenia in major surgical patients. Sarcopenia was associated with high payer costs and negative margins after major surgery.

    Article  PubMed  Google Scholar 

  17. Du Y, Karvellas CJ, Baracos V, Williams DC, Khadaroo RG. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery. Surgery. 2014;156(3):521–7.

    Article  PubMed  Google Scholar 

  18. Harimoto N, Shirabe K, Yamashita YI, Ikegami T, Yoshizumi T, Soejima Y, et al. Sarcopenia as a predictor of prognosis in patients following hepatectomy for hepatocellular carcinoma. Br J Surg. 2013;100(11):1523–30.

    Article  CAS  PubMed  Google Scholar 

  19. Peng P, Hyder O, Firoozmand A, Kneuertz P, Schulick RD, Huang D, et al. Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg: Off J Soc Surg Aliment Tract. 2012;16(8):1478–86.

    Article  Google Scholar 

  20. Kuroki LM, Mangano M, Allsworth JE, Menias CO, Massad LS, Powell MA, et al. Pre-operative assessment of muscle mass to predict surgical complications and prognosis in patients with endometrial cancer. Ann Surg Oncol. 2014.

  21. Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55(1):164–74.

    Article  PubMed  Google Scholar 

  22. Svatek RS, Fisher MB, Matin SF, Kamat AM, Grossman HB, Nogueras-Gonzalez GM, et al. Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J Urol. 2010;183(3):929–34.

    Article  PubMed  Google Scholar 

  23. Hautmann RE, Gschwend JE, de Petriconi RC, Kron M, Volkmer BG. Cystectomy for transitional cell carcinoma of the bladder: results of a surgery only series in the neobladder era. J Urol. 2006;176(2):486–92. discussion 91-2.

    Article  PubMed  Google Scholar 

  24. Jensen BT, Jensen JB, Laustsen S, Petersen AK, Sondergaard I, Borre M. Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial. J Multidiscip Healthc. 2014;7:301–11.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Smith AB, Deal AM, Yu H, Boyd B, Matthews J, Wallen EM, et al. Sarcopenia as a predictor of complications and survival following radical cystectomy. J Urol. 2014;191(6):1714–20.

    Article  PubMed  Google Scholar 

  26. Ahmadi H, Terjimanian M, Chernin AS, Daignault-Newton S, All-Attar N, Dailey S, et al. MP60-13 PSOAS muscle mass as a predictor of survival in patients who undergo radical cystectomy. J Urol. 2014;191(4):e637.

    Article  Google Scholar 

  27. Psutka SP, Carrasco A, Schmit GD, Moynagh MR, Boorjian SA, Frank I, et al. Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancer-specific and all-cause mortality. Cancer. 2014;120(18):2910–8. This study was one of the first to report associations between sarcopenia and survival in patients undergoing radical cystectomy.

    Article  PubMed  Google Scholar 

  28. Roth B, Birkhauser FD, Zehnder P, Thalmann GN, Huwyler M, Burkhard FC, et al. Parenteral nutrition does not improve postoperative recovery from radical cystectomy: results of a prospective randomised trial. Eur Urol. 2013;63(3):475–82.

    Article  PubMed  Google Scholar 

  29. Hupe M, Kramer M, Merseburger A. Preoperative and modifiable factors to lower postoperative complications after radical cystectomy. Curr Urol Rep. 2015;16(4):1–5. English.

    Article  Google Scholar 

  30. Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS((R))) society recommendations. Clin Nutr. 2013;32(6):879–87.

    Article  PubMed  Google Scholar 

  31. Daneshmand S, Ahmadi H, Schuckman AK, Mitra AP, Cai J, Miranda G, et al. Enhanced recovery protocol after radical cystectomy for bladder cancer. J Urol. 2014;192(1):50–5.

    Article  PubMed  Google Scholar 

  32. Porserud A, Sherif A, Tollback A. The effects of a physical exercise programme after radical cystectomy for urinary bladder cancer. A pilot randomized controlled trial. Clin Rehabil. 2014;28(5):451–9.

    Article  PubMed  Google Scholar 

  33. Burton LA, Sumukadas D. Optimal management of sarcopenia. Clin Int Aging. 2010;5:217–28.

    CAS  Google Scholar 

  34. Friedman J, Lussiez A, Sullivan J, Wang S, Englesbe M. Implications of sarcopenia in major surgery. Nutr Clin Pract: Off Publ Am Soc Parent Enter Nutr. 2015;30(2):175–9.

    Article  Google Scholar 

  35. Lee CT, Madii R, Daignault S, Dunn RL, Zhang Y, Montie JE, et al. Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival. [see comment]. J Urol. 2006;175(4):1262–7. discussion 7.

    Article  PubMed  Google Scholar 

  36. Alva AS, Tallman CT, He C, Hussain MH, Hafez K, Montie JE, et al. Efficient delivery of radical cystectomy after neoadjuvant chemotherapy for muscle-invasive bladder cancer: a multidisciplinary approach. Cancer. 2011.

  37. Oliver J, Vemana G, Vetter J, Strope S, Menias C, Wildes T, et al. 1626 Sarcopenia predicts post-operative complications and length of stay following radical cystectomy. J Urol. 2013;189(4):e668–9.

    Article  Google Scholar 

  38. Wan F, Zhu Y, Gu C, Yao X, Shen Y, Dai B, et al. Lower skeletal muscle index and early complications in patients undergoing radical cystectomy for bladder cancer. World J Surg Oncol. 2014;12:14.

    Article  PubMed Central  PubMed  Google Scholar 

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Conflict of Interest

Hamed Ahmadi, James E. Montie, Alon Z. Weizer, Todd Morgan, Jeffrey S. Montgomery, and Cheryl T. Lee each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Cheryl T. Lee.

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This article is part of the Topical Collection on Urothelial Cancer

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Ahmadi, H., Montie, J.E., Weizer, A.Z. et al. Patient Psoas Muscle Mass as a Predictor of Complications and Survival After Radical Cystectomy. Curr Urol Rep 16, 79 (2015). https://doi.org/10.1007/s11934-015-0548-0

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  • DOI: https://doi.org/10.1007/s11934-015-0548-0

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