Influence of the effectiveness of sarcopenia on postoperative major complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal surface malignancy: a retrospective cohort study

Our plain-English summary of Influence of the effectiveness of sarcopenia on postoperative major complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal surface malignancy: a retrospective cohort study, by N. Havan, S. Gülmez, A.S. Senger, et al (International Journal of Colorectal Disease, 2025).

The study

• Authors: N. Havan, S. Gülmez, A.S. Senger, O. Uzun, M. Dinçer, Ö. Özduman, D. Avan, A. Polat, E. Polat, M. Duman
• Journal: International Journal of Colorectal Disease
• Published: 2025;40(1):96
• Type of article: Letter
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background And Purpose: Sarcopenia has recently been gaining importance due to its role on mortality and mobility in diseases and operations. In this study, we aimed to evaluate the effect of sarcopenia on major postoperative complications in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancy.

Methods: In this longitudinal cohort study included 202 patients treated between January 2018 and September 2023, with 52 undergoing prophylactic procedures. Peritoneal metastases originated from colorectal, gastric, and ovarian cancer; peritoneal mesothelioma; mucinous adenocarcinoma of the appendix; and endometrial cancer. Age, sex, body mass index (BMI), length of hospital stay (LOS), peritoneal cancer index (PCI), competency of cytoreduction (CC), operation time, and primary peritoneal carcinomatosis were recorded. All variables were analyzed according to the presence of major complications and sarcopenia.

Results: Significant associations were found between major complications and sarcopenia (p = 0.002), PCI (p = 0.036), operation time (p = 0.015), and LOS (p < 0.001). In sarcopenic patients, significant associations were found with sex (p = 0.035), age (p = 0.025), and BMI (p = 0.001). Multivariate Cox regression analysis identified sarcopenia as an independent risk factor for major complications, tripling the likelihood (p = 0.005). Additionally, PCI score (p = 0.008) and LOS (p < 0.001) were independent risk factors.

Conclusion: This study underscores sarcopenia as an independent risk factor for major complications in CRS/HIPEC patients, with PCI and LOS as additional risk factors. In sarcopenic patients, pre-operative evaluation should be done carefully and post-operative risks should be kept in mind.

© 2025. The Author(s).

In plain English

This retrospective cohort study, from a hospital in Istanbul, Turkey, looked at 202 patients who had cytoreductive surgery plus heated abdominal chemotherapy (HIPEC) between January 2018 and September 2023. Fifty-two had the procedure as a preventive measure. The cancers treated originated from colorectal, gastric, ovarian, appendix or endometrial cancer, or were peritoneal mesothelioma (13 patients). The article does not mention asbestos. Sarcopenia (low muscle mass) was judged from psoas muscle size on CT scans taken before surgery. It was found in 54 patients (26.7%). Major complications within 30 days occurred in 22 of the 54 sarcopenic patients (40.7%) and in 29 of the 148 patients without sarcopenia (19.6%). In a multivariate analysis, sarcopenia was linked to about three times the odds of major complications (odds ratio 3.139, 95% CI 1.402 to 7.026). A higher peritoneal cancer index and a longer hospital stay were also linked. Seven of the 13 mesothelioma patients had major complications. The authors concluded that sarcopenia was an independent risk factor, and noted that the study was retrospective.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective cohort study (single center)
• Who was studied: 202 patients treated with cytoreductive surgery and HIPEC at one center in Turkey (Istanbul Koşuyolu High Specialization Education and Research Hospital) from January 2018 to September 2023. Of these, 52 had a prophylactic procedure. The article lists the cancer origins as colorectal, gastric, ovarian, mucinous adenocarcinoma of the appendix and endometrial cancer, plus peritoneal mesothelioma.
• Exposure: Sarcopenia (low skeletal muscle mass), measured on preoperative CT as psoas muscle area at the third lumbar vertebra divided by height squared. The cut-offs were below 52.4 cm2/m2 for men and below 38.5 cm2/m2 for women. Asbestos exposure was not studied.
• Main results:
  • Sarcopenia was found in 54 of 202 patients (26.7%). Of these 54, 22 (40.7%) had major complications (Clavien-Dindo grade 3 or higher), a statistically significant association (p = 0.002).
  • Among the 148 patients without sarcopenia, 29 (19.6%) had severe complications.
  • In the multivariate analysis, the odds ratio for major complications with sarcopenia present was 3.139 (95% CI 1.402 to 7.026, p = 0.005). The authors described this as roughly threefold.
  • Sarcopenia, the peritoneal cancer index (PCI) and length of hospital stay were identified as independent risk factors for major complications. The PCI odds ratio was 1.110 (95% CI 1.028 to 1.200). The length-of-stay odds ratio was 1.125 (95% CI 1.067 to 1.186). Operation time was not significant in that analysis (p = 0.157).
  • Patients with major complications had a median PCI of 8 (interquartile range 1 to 16), compared with 3 (1 to 9) in patients without major complications (p = 0.036). Their median hospital stay was 18 days, versus 8 days for patients without major complications.
  • Among patients with peritoneal mesothelioma, 7 of 13 (53.8%) had major complications, the highest proportion of any tumor origin. Table 2 shows sarcopenia in 1 of the 13 mesothelioma patients (7.7%).
  • Sarcopenic patients were older (median 58 vs 55 years, p = 0.025). Sarcopenia was more common in women than in men (36 vs 18).
  • No significant differences were found between prophylactic and therapeutic HIPEC patients in major complications or sarcopenia.
• The authors' conclusion: The authors concluded that sarcopenia was an independent risk factor for major complications in CRS/HIPEC patients, with PCI and length of stay as the other risk factors. They called for validation in multicenter studies with large samples.
• Limitations the authors state:
  • The study was retrospective.
  • Prophylactic HIPEC patients were included, and their lower tumor burden may make them less susceptible to sarcopenia.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Cohort Study, Ovarian Cancer, Peritoneal Mesothelioma, Adenocarcinoma, Peritoneal Cancer Index (PCI).

Related studies

• Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia — A. Galan, P. Rousset, et al. (2018)
• Risk factors for postoperative acute kidney injury after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: a meta-analysis and systematic review — D. Chen, Y. Ma, et al. (2025)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)
• Impact of Major Complications on Patients' Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy — T.D. Hamilton, E.L. Taylor, et al. (2016)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Outcomes of multicystic peritoneal mesothelioma treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — A. Zahid, L. Clarke, et al. (2021)

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