The impact of acute skeletal muscle loss after gastrointestinal cancer surgery on physical function.

INTRODUCTION: Significant skeletal muscle loss occurs commonly after cancer surgery; however, the impact of postoperative acute skeletal muscle loss on physical function remains poorly understood. OBJECTIVE: To determine the impact of surgery-associated acute skeletal muscle wasting on physical function in the early postoperative period in patients with gastrointestinal cancer. DESIGN: A single-center retrospective observational study. SETTING: General hospital. PATIENTS: Hospitalized patients with gastrointestinal cancer who were admitted for surgery. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The main outcome was the partial correlation between postoperative changes in skeletal muscle index (SMI) and physical function such as handgrip strength, gait speed, and 6-minute walk test. RESULTS: A total of 69 patients (41 male and 28 female) with a mean age of 70.5 years were included. SMI was significantly correlated with physical function, such as handgrip strength (r = 0.757, p < .001), maximum gait speed (r = 0.318, p = .008), and 6-minute walk test (r = 0.365, p = .002) before surgery. In contrast, partial correlation analysis between the absolute changes in SMI and physical function after controlling for SMI and each physical function before surgery showed no significant correlation. Multivariable linear regression analyses also showed that postoperative change in SMI was not significantly associated with the postoperative change in physical function but it was associated with the length of stay after surgery, SMI at admission, and absolute change in body fat percentage. CONCLUSIONS: The absolute change in SMI during the early postoperative period was not linearly correlated with the degree of decline in physical function. Further studies are necessary to investigate the effects of the respective changes in skeletal muscle mass and physical function on clinical outcomes.

Association between postextubation dysphagia and physical function in survivors of critical illness: A retrospective study.

BACKGROUND & AIMS: Dysphagia following endotracheal intubation, also known as postextubation dysphagia (PED), is generally observed in survivors of critical illness. However, its association with physical function remains relatively unexplored. This study aimed to investigate the association between PED and physical function in patients after intensive care. METHODS: This is a single-center retrospective observational study. Medical records of adult patients who required emergency admission and were intubated and mechanically ventilated were retrospectively reviewed. Swallowing and physical function were assessed using the Food Intake Level Scale (FILS) and functional status score for the intensive care unit (FSS-ICU) at discharge, respectively. Multivariable linear and logistic regression analyses were used to analyze the association between dysphagia and physical dysfunction at discharge. RESULTS: A total of 103 patients (63 men and 40 women) with a mean age of 67.3 years were enrolled. PED was observed in 20 patients (19.4%) at hospital discharge. The FILS score at hospital discharge was significantly and independently associated with the FSS-ICU (ß = 0.458, p < 0.001); however, the FILS score was not an independent risk factor for non-home discharge (95% confidence interval, 0.547-1.160). CONCLUSIONS: PED is significantly associated with physical dysfunction at discharge in survivors of critical illness. PED should be considered as a component of post-intensive care syndrome, and early intervention to prevent and improve swallowing dysfunction may be necessary.

Resistance Exercise After Laparoscopic Surgery Enhances Improvement in Exercise Tolerance in Geriatric Patients With Gastrointestinal Cancer.

INTRODUCTION:  Early mobilization after cancer surgery is generally recommended. However, the effects of postoperative resistance exercise during a hospital stay have been rarely investigated. This study aimed to clarify the effects of resistance exercise after laparoscopic surgery on exercise tolerance and skeletal muscle mass in geriatric patients with gastrointestinal cancer. METHODS: This single-center retrospective observational study included patients with gastrointestinal cancer who admitted for laparoscopic surgery. Exercise tolerance and skeletal muscle mass were assessed using a six-minute walking test (6MWT) and skeletal muscle index (SMI) at admission and discharge, respectively. Intergroup comparisons of absolute changes in 6MWT and SMI were analyzed by the unpaired t-test or Mann-Whitney U test according to whether resistance exercise was performed or not. Multivariable linear regression analyses were used to analyze the association of resistance exercise with changes in 6MWT and SMI. The analyses were adjusted for age, sex, cancer stage, postoperative complication, and preoperative exercise tolerance and skeletal muscle mass. RESULTS: Altogether, 66 patients (mean age 69.9 years; 60.6% men) were recruited. Of them, 72.7% performed the resistance exercise and started at a median of 4.5 postoperative days. There were no significant intergroup differences in absolute changes in the 6MWT and the SMI (p = 0.153, p = 0.476, respectively). Multivariable linear regression analysis showed that resistance exercise was independently and positively associated with the 6MWT at discharge (ß = 1.70, 95% confidence interval, 1.88 to 71.09) and did not significantly contribute to the SMI at discharge (95% confidence interval, -0.21 to 0.27). CONCLUSION: Resistance exercise may enhance the improvement in postoperative exercise tolerance in geriatric patients with gastrointestinal cancer who underwent laparoscopic surgery.

The associations between nutritional status, physical function and skeletal muscle mass of geriatric patients with colorectal cancer.

BACKGROUND & AIMS: Nutritional status is associated with physical function and body composition. However, these relationships in patients with colorectal cancer remain poorly understood. This study aimed to investigate the association between nutritional status, physical function, and skeletal muscle mass in geriatric patients with colorectal cancer. METHODS: Preoperative patients diagnosed with colorectal cancer were recruited for this cross-sectional observational study. The correlations were calculated using Spearman's rank correlation coefficient, and the intergroup differences in physical function and skeletal muscle mass between categories according to nutritional assessment were analyzed using the Mann-Whitney U test or Kruskal-Wallis test. RESULTS: We recruited 127 patients (median age 71.0 years). Hand grip strength was correlated with geriatric nutritional risk index (GNRI) (male: p = 0.033; female: p = 0.014), albumin (male: p = 0.014; female: p = 0.003), and controlling nutritional status (CONUT) score (male: p = 0.004; female: p = 0.011) in both gender, and correlated with body mass index (BMI) (p = 0.027) in male patients. Psoas volume index (PVI) was positively correlated with BMI (male: p = 0.005; female: p < 0.001). In addition, intergroup comparisons for categories according to BMI showed PVI was significantly lower in the malnutrition category (male: p = 0.017; female: p < 0.001). Albumin and CONUT score were correlated with five-times sit-to-stand test (male: p = 0.011; female: p = 0.049, male: p = 0.031; female: p = 0.012, respectively) and short physical performance battery (male: p = 0.065; female: p = 0.028, male: p = 0.002; female: p = 0.006, respectively). Moreover, patients in lower albumin category had longer time on 5-times sit-to-stand test (male: p = 0.018; female: p = 0.009) and had lower scores on short physical performance battery (male: p = 0.027; female: p = 0.039). CONCLUSIONS: Hand grip strength correlated with various nutritional assessment tools, and PVI was correlated with BMI in particular. Five-times sit-to-stand test and short physical performance battery were correlated with serum albumin concentration and CONUT score. Physical function and skeletal muscle mass are associated with nutritional status, and hand grip strength might be more strongly associated with nutritional status.

Perioperative physical and nutritional therapy for tongue cancer-induced malnutrition and muscle atrophy: A case report.

Malnutrition is a common complication in patients with tongue cancer who experience dysphagia and can steadily lead to skeletal muscle atrophy. Additionally, skeletal muscle loss commonly occurs in patients after invasive surgery. Therefore, patients with tongue cancer are at high risk of skeletal muscle atrophy during the perioperative phase of treatment. Over time, physical and nutritional therapy are expected to increase skeletal muscle mass and improve nutritional status. However, immediate benefits for patients in the perioperative phase of treatment are largely unknown. This case report aimed to evaluate the combined effects of physical and nutritional therapy for a patient in the perioperative phase of treatment for tongue cancer. We describe a 48-year-old woman diagnosed with tongue cancer. Her increasing difficulty with eating and swallowing led to malnutrition. After hospital admission for oral surgery, physical and nutritional therapy were initiated. Skeletal muscle mass measured by body composition analyzer and ultrasound apparatus showed increases, whereas blood tests to indicate nutritional status showed no improvement. This case suggests that physical and nutritional therapy are effective for increasing skeletal muscle during perioperative phase treatment in malnourished patients with tongue cancer and assessment of skeletal muscle mass is a reliable method for clinical evaluation.