Sarcopenia as a predictor of complications in penile cancer patients undergoing inguinal lymph node dissection

Purpose Lymphadenectomy (LND) is part of the surgical management of penile cancer but causes significant perioperative morbidity. We determined whether sarcopenia, a novel marker of nutritional status, is a predictor of postoperative complications after LND. Materials and methods Seventy-nine patien...

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Bibliographic Details
Published in:World journal of urology 2015-10, Vol.33 (10), p.1585-1592
Main Authors: Sharma, Pranav, Zargar-Shoshtari, Kamran, Caracciolo, Jamie T., Richard, George J., Poch, Michael A., Pow-Sang, Julio, Sexton, Wade J., Spiess, Philippe E.
Format: Article
Language:English
Subjects:
Aged
Biopsy
Florida - epidemiology
Humans
Inguinal Canal
Lymph Node Excision - methods
Lymphatic Metastasis
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Morbidity - trends
Nephrology
Oncology
Original Article
Penile Neoplasms - diagnosis
Penile Neoplasms - secondary
Penile Neoplasms - surgery
Postoperative Complications - diagnosis
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Prognosis
Retrospective Studies
Sarcopenia - complications
Sarcopenia - diagnosis
Sarcopenia - epidemiology
Tomography, X-Ray Computed
Urology
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Summary:Purpose Lymphadenectomy (LND) is part of the surgical management of penile cancer but causes significant perioperative morbidity. We determined whether sarcopenia, a novel marker of nutritional status, is a predictor of postoperative complications after LND. Materials and methods Seventy-nine patients underwent LND for penile cancer from 1999 to 2014, and 43 had available preoperative abdominal imaging. Skeletal muscle index (SMI) was calculated on axial computed tomography images at the third lumbar vertebrae, and an SMI of 55 cm 2 /m 2 was used to classify patients as sarcopenic versus not. This classification was then correlated with postoperative complications and survival. Results Median lumbar SMI was 54.7 cm 2 /m 2 with 22 (51.2 %) patients categorized as sarcopenic versus 21 (48.8 %) who were not. Twenty-seven postoperative complications occurred in 20 patients within 30 days, of which 11 (40.7 %) were major (Clavien score ≥IIIa) and 16 (59.3 %) were minor. The most common complications were wound dehiscence (25.9 %), wound infection (18.5 %), lymphocele (18.5 %), and flap necrosis (14.8 %). On univariate analysis, the presence of sarcopenia, nodal disease, and lymphovascular invasion were predictors of postoperative complications. On multivariate analysis, only sarcopenia was an independent predictor of 30-day complications [ p  = 0.038; 95 % confidence interval (CI) 1.1–21.1]. Although sarcopenia was not statistically associated with worse overall survival (OS), there was a trend toward poorer outcomes in these patients. Conclusions Sarcopenia can be a useful prognostic tool to predict the likelihood of postoperative complications after LND for penile cancer. Preoperative nutritional supplementation may help reduce complication rates in the future.
ISSN:0724-4983
1433-8726
DOI:10.1007/s00345-014-1471-6