eP332 - The Impact of Sarcopenia on Post-operative Outcomes for Patients Undergoing Surgery for Colorectal Cancer: An Updated Systematic Review and Meta-analysis

Purpose/Background: Sarcopenia is thought to be a marker for underlying frailty and malnutrition, contributing to poor functional status and suboptimal healing postoperatively. Previous studies, including meta-analyses, have shown that sarcopenia correlates with adverse outcomes following colorectal cancer surgery. However, further observational studies have been published since the most recent data synthesis. As such, we aimed to complete an updated systematic review and meta-analysis evaluating the impact of sarcopenia on short- and long-term outcomes following colorectal surgery.Methods/Interventions: This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search in MEDLINE, Embase, and CENTRAL from database inception to September 2023 was performed. Studies that compared sarcopenic and non-sarcopenic patients’ short- and long-term outcomes following curative intent surgery for colorectal cancer were included. The main outcomes included overall survival (OS), disease free survival (DFS), length of stay (LOS), postoperative morbidity, anastomotic leaks, ICU admissions, re-operation and re-admissions. A pair-wise meta-analysis was performed using an inverse variance random effects model. Risk of bias was assessed with Cochrane risk of bias tools.Results/Outcomes: After screening 150 studies, we included 41 non-randomized studies, totalling over thirteen thousand patients, of which 5523 (40.4%) were classified as sarcopenic. Across 28 studies, pooled analysis found that patients with sarcopenia were more likely to experience 30-day postoperative morbidity (44 vs. 38%, RR 1.28, 95% CI 1.11-1.48, p=0.00). Upon pooling data from 13 studies, sarcopenic patients also had a higher 30-day postoperative mortality rate (2% vs. 1%, RR 2.74, 95% CI 1.63-4.62, p=0.00). The mean postoperative LOS was 1.46 days longer for sarcopenic patients (26 studies, 95% CI 0.85-2.07, p=0.00). Patients with sarcopenia also were more likely to be readmitted within 30 days of surgery (12 studies, RR 1.63 95% CI 1.07-2.49, p=0.02). Regarding long-term outcomes, patients with sarcopenia had lower 5-year DFS (4 studies, RR 0.91, 95% CI 0.84-0.98, p=0.01) compared with those without sarcopenia. However, five-year OS did not show a significant difference between sarcopenic and non-sarcopenic patients (3 studies, RR 0.88, 95% CI 0.76-1.03, p=0.11). Risk of bias was mostly uncertain-to-high across included studies.Conclusion/

Discussion: The findings from this systematic review and meta-analysis suggest that in patients who are undergoing curative intent surgery for colorectal cancer, preoperative sarcopenia is associated with poor short- and long-term postoperative outcomes. These data are in keeping with previous evidence synthesis studies and highlight the need for effective preoperative interventions to optimize these patients prior to colorectal surgery.Post-Operative Morbidity in Sarcopenic vs Non-Sarcopenic Patients