Physical performance has a strong association with poor surgical outcome in older patients with colorectal cancer

Esteban TD Souwer*, Shira I. Moos, Cornelis J. van Rooden, Astrid Y. Bijlsma, Esther Bastiaannet, Willem H. Steup, Jan Willem T. Dekker, Marta Fiocco, Frederiek van den Bos, Johanna EA Portielje

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Low lumbar skeletal muscle mass and density have been associated with adverse outcomes in different populations with colorectal cancer (CRC). We aimed to determine whether skeletal muscle mass, density, and physical performance are associated with postoperative complications and overall survival (OS) in older CRC patients. Methods: We analysed consecutive patients (≥70 years) undergoing elective surgery for non-metastatic CRC (stage I-III). Lumbar skeletal muscle mass and muscle density were measured using abdominal CT-images obtained prior to surgery. Low skeletal muscle mass and low muscle density were defined using commonly used thresholds and by gender-specific quartiles (Q). The preoperative use of a mobility aid served as a marker for physical performance. Cox regression proportional hazard models were used to investigate the association between the independent variables and OS. Results: 174 Patients were included (mean age 78.0), with median follow-up 2.6 years. 36 Patients (21%) used a mobility aid preoperatively. Low muscle density (Q1 vs Q4) and not muscle mass was associated with worse postoperative outcomes, including severe complications (p < 0.05). Use of a mobility aid was associated with more complications, including severe complications (39% vs 17%, p = 0.004) and OS (HR 2.65, CI 1.29–5.44, p = 0.01). However, patients with mobility aid use and low skeletal muscle mass had worse OS (HR 5.68, p = 0.003). Conclusion: Low skeletal muscle density and not muscle mass was associated with more complications after colorectal surgery in older patients. Physical performance has the strongest association for poor surgical outcomes and should be investigated when measuring skeletal muscle mass and density.

Original languageEnglish
Pages (from-to)462-469
Number of pages8
JournalEuropean Journal of Surgical Oncology
Issue number3
Publication statusPublished - 1 Mar 2020


  • Aged
  • Body composition
  • Colorectal neoplasms
  • Overall survival
  • Physical performance
  • Postoperative complications
  • Sarcopenia


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