EP767 - Importance of ERAS compliance on long-term survival of Sarcopenia diagnosed with Bioelectrical impedance analysis (BIA) for colorectal cancer surgery.

Purpose/Background: Sarcopenia, characterized by the loss of skeletal muscle mass (SMM) and strength, has been identified as a significant factor contributing to postoperative morbidity, mortality, and poorer survival rates. It was demonstrated that low SMM is influenced by systemic inflammatory response, which play a role in the muscle wasting in primary colorectal cancer. Therefore, the accurate assessment of sarcopenia is crucial before surgery.
In clinical practice, abdomen CT scan are usually used for sarcopenia assessment. However, bioelectrical impedance analysis(BIA) is a relatively simple and noninvasive method that has shown a correlation with SMM estimated via CT scans.
In this study, we aimed to diagnose sarcopenia using BIA in patients with colorectal cancer and evaluate postoperative complications and long-term survival outcomes between sarcopnia and non-sarcopenia pateints. Additionally, we explored the relationship between sarcopenia and compliance with an Enhanced Recovery After Surgery (ERAS) protocols in long term survival.

Methods/Interventions: The study included patients who underwent elective surgery for colorectal cancer at Seoul St. Mary's Hospital from July 1, 2018, to December 31, 2021. All patients were subjected to EARS protocol. Patients with stage I, II, and III cancer without distant metastasis were included. The assessment for sarcopenia was conducted for all patients both preoperatively and before discharge using BIA measurements. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) consensus, employing specific thresholds of less than 7.0 kg/m² for men and less than 5.7 kg/m² for women.

Results/Outcomes: A total of 616 patients were included in the study. Among them, 126 patients were identified as sarcopenia and 490 as non-sarcopenia. The sarcopenia group were significantly older than non-sarcopenia group (71.04 vs 63.68years, p< 0.001). Patients with sarcopneia had fewer diabetes and more cardiovascular and pulmonary diseases. There was a significant higher incidence of intestinal obstruction, and more advanced TNM stages II and III.
Measurements obtained through BIA indicated that BMI, total body water, protein, mineral, and phase angle were all significantly lower in the sarcopenia. Several inflammatory markers were higher in sarcopenia, but albumin reflected to nutrition status was significantly lower.
When comparing long-term survival, such as disease-free survival (DFS) and overall survival (OS), no significant differences were observed between the sarcopenia and non-sarcopenia groups. However, when comparing based on ERAS compliance rate in sarcopenia group, compliance < 70 demonstrated significantly lower OS in those with compliance ≥70. Consequently, we compared DFS and OS among three groups: sarcopenia patients with compliance above 70, sarcopenia patients with compliance below 70, and the non-sarcopenia group. The OS was not significantly different between the non-sarcopenia group and sarcopenia patients with compliance above 70, but a significant difference was observed when compared to sarcopenia patients with compliance below 70.

Conclusion/Discussion: Evaluating sarcopenia before surgery using BIA, more actively applying in perioperative care with ERAS protocols and improving high compliance leads to better long term survival outcomes in patients with sarcopenia.

3-years survival rates according to the relationship between Sarcopenia and ERAS compliance
when comparing based on ERAS compliance rate in sarcopenia group, compliance <70 demonstrated significantly lower OS in those with compliance ≥70. Consequently, we compared DFS and OS among three groups: sarcopenia patients with compliance above 70, sarcopenia patients with compliance below 70, and the non-sarcopenia group. The OS was not significantly different between the non-sarcopenia group and sarcopenia patients with compliance above 70, but a significant difference was observed when compared to sarcopenia patients with compliance below 70.

Univariate and Multivariate analysis on related factors for 3-year overall survival
3 year overall survival related factors were analyzed on univariate and multivariate analysis. Age over 65years, ASA score over 3, and sarcopenia with ERAS compliance below 70% were identified of related factors. So, Patients with sarcopenia and ERAS compliance below 70% were decreased 3-years overall survival with significant difference.