Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

The Prehab Muscle Shuffle: Prevalence and Trajectory of Sarcopenia in a Multimodal Prehabilitation Program for Gastrointestinal Cancer Surgery   (126632)

Kristy-Lee Raso 1 2 , Michael David 3 , Jane Turner 4 , Michael Suen 5 , Sim Yee (Cindy) Tan 1 2 4 , Janette Vardy 1 4
  1. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  2. Nutrition and Dietetics, Concord Hospital, Concord, NSW, Australia
  3. The Daffodil Centre, A Joint Venture with Cancer Council NSW, The University of Sydney, Syndey, New South Wales, Australia
  4. Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia
  5. Concord Hospital, Concord, NSW, Australia

Objectives/purpose: Sarcopenia, characterised by reduced muscle mass and strength, is common in patients undergoing gastrointestinal cancer surgery and is associated with poorer postoperative outcomes. Multimodal prehabilitation, including exercise, nutrition, and psychosocial support, may help mitigate this risk. However, real-world longitudinal data remain limited. We examined changes in sarcopenia incidence over time in a prehabilitation cohort.

Sample and setting: Eligible patients scheduled for curative gastrointestinal cancer surgery at Concord Hospital (2020–2021) participated in a 2–4-week multimodal prehabilitation program.

Procedures: Sarcopenia was assessed at baseline (T0), pre-surgery (T1), and 30-days post-surgery (T2), using The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria: skeletal muscle index (via bioimpedance) and handgrip strength. Missing data were managed using multiple imputation. Generalised linear and regression models assessed changes in sarcopenia and associations with length of stay (LOS) and complications. The SARC-F (score ≥4), a simple patient-completed sarcopenia screening tool, was evaluated against EWGSOP2 criteria using receiver operating characteristic analysis.

Results: Seventy‐two patients (mean age 67±12.7 years; 58% male; 83% colorectal cancer) were included. Sarcopenia incidence declined from 17% at T0 to 4% at T1 (p=0.008), with a slight increase to 7% at T2 (p=0.48). The odds of sarcopenia were significantly lower at T1 versus T0 (OR=0.48, 95% CI:0.25–0.95, p=0.036), with a non-significant rise at T2 (OR=4.67, 95% CI:0.67–32.38, p=0.119). Baseline sarcopenia was more common in upper gastrointestinal cancer patients (66.7% vs 33.3%, p=0.090). A SARC-F score ≥4 showed strong predictive accuracy in detecting sarcopenia at T0 (AUC=0.879, p<0.001) and T1 (AUC=0.939, p<0.001), but not at T2 (AUC=0.690, p=0.122).

Conclusion and clinical implications: Rates of sarcopenia were overall low, with a suggestion of improvement following multimodal prehabilitation. The SARC-F shows promise as a sarcopenia screening tool in a prehabilitation setting; however, further research in this context is needed.