TTP3.13 Laparoscopic and Robotic Surgery for Colorectal Cancer in Patients with Sarcopenia: A Systematic Review

Aims Sarcopenia has a negative effect on outcomes after open colorectal cancer (CRC) surgery. Laparoscopic and robotic surgery have been associated with improved outcomes compared to open surgery for CRC, however the effect of these minimally invasive approaches in CRC patients with sarcopenia is unclear. Methods The databases PubMed, Embase and Medline were searched systematically according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The outcomes assessed were postoperative complications (Clavien-Dindo Classification), length of stay (LOS), overall survival (OS) and disease-free survival (DFS). Results 9 studies were included in the synthesis of results. The total number of patients was 1564 including 433 sarcopenic patients. 3 studies demonstrated a statistically significant association between sarcopenia and worse postoperative complications. 2 studies reported a decrease in overall survival (OS) in sarcopenic patients, p=0.02 and p=0.046. However, no significant difference in disease-free survival (DFS) and length of stay (LOS) was observed. 6 studies measured sarcopenia using skeletal muscle index (SMI) while 3 studies used psoas muscle index (PMI), calculated from L3 CT. Conclusion Sarcopenia has a significant effect on the rate of postoperative complications and overall survival in patients with CRC undergoing minimally invasive surgery. In contrast, this review found no evidence that length of hospital stay or disease-free survival were affected. Further work is needed to better characterise the effect of sarcopenia on outcomes, ideally with a randomised control trial. Sarcopenia may be a target for pre-operative intervention (i.e. prehabilitation) in the future but more robust data is needed.