Sarcopenia is associated with higher surgical complexity in patients undergoing interval cytoreduction for advanced epithelial ovarian carcinoma

Objectives: Loss of skeletal muscle mass (sarcopenia) has been correlated with adverse postoperative outcomes after primary cytoreduction in patients with epithelial ovarian carcinoma (EOC). We investigated the association between sarcopenia as measured by skeletal muscle index (SMI) prior to and after neoadjuvant chemotherapy (NACT) and post-operative outcomes following interval cytoreduction for EOC. Methods: Patients undergoing NACT for EOC between 2007-2020 were identified through our institutional database. A retrospective review was performed to identify cancer-specific, preoperative, surgical, and post-operative variables. Pretreatment and post-treatment contrast-enhanced CT scans were reviewed by two subspecialty radiologists to determine skeletal muscle index (SMI). SMI was calculated by dividing total psoas and paraspinal muscle area (m2) (measured at the level of L4 vertebrae) by height squared (cm2). Patients were grouped based on SMI into Group 1) patients with >2% decrease in SMI, and Group 2) patients with an increase or less than or equal to 2% decrease in SMI after NACT. SMI was also analyzed as a continuous variable for association with demographic and clinical factors by Kruskal-Wallis test/Spearman's correlation (results summarized as median [25th, 75th percentiles]). Results: A total of 77 patients met the inclusion criteria. Baseline demographic characteristics were consistent between group 1 and 2 patients. Baseline CA125 was significantly higher in group 2 patients (increase or less than or equal to 2% decrease in SMI) (p=0.031). However, change in SMI was not significantly associated with surgical or postoperative outcomes. When analyzed as a continuous variable, SMI was correlated with higher surgical complexity score (SCS); patients with low SCS had a median SMI of 20.7 m2/cm2 vs 23.6 and 23.8 m2/cm2 for intermediate and high SCS, respectively (p=0.01). Length of surgery was also positively correlated with SMI (0.29, (0.05, 0.51), p=0.021) (Table 1). There was no association between SMI and readmission rates, length of hospital stay, postoperative complications, or non-home discharge. Download : Download high-res image (135KB) Download : Download full-size image Conclusions: Higher SMI is predictive of longer operative time and higher SCS in patients undergoing interval debulking, but was not predictive of postoperative outcomes, complications, length of stay, or non-home discharge in this study. These data suggest that SMI may be a surrogate for extent of interval surgical debulking. A larger population of NACT patients is being evaluated to determine more robust correlations in postoperative outcomes.