Head & Neck Session
AB174. SOH26AB_0327. Pre-operative sarcopenia in head and neck reconstruction—implications for survival and perioperative complication rates: a meta-analysis
Ailbhe Coyle1,2, Cian Hehir1, Lorcan Lalor1, Gavin Dowling1,2, Niamh Smyth1,2, James Martin-Smith1,2, Barry O’Sullivan2, Roisin Dolan3,4
1Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland;
2Department of Plastic, Reconstructive, and Aesthetic Surgery, Beaumont Hospital, Dublin, Ireland;
3Department of Plastic, Reconstructive, and Aesthetic Surgery, St. Vincent’s University Hospital, Dublin, Ireland;
4Catherine McCauley Centre, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
Background: Sarcopenia refers to a systemic loss in skeletal muscle mass with an associated decline in muscular function. Sarcopenia has demonstrated a significant pre-operative capacity to predict patients at risk of perioperative morbidity and inferior survival rates. We aimed to examine the effects of preoperative sarcopenia on survival and complication rates.
Methods: A systematic search was performed of online research repositories in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies reporting on perioperative complication rates and postoperative outcome measures in patients undergoing head and neck cancer resection with reconstruction were identified. Included studies must report data relevant to radiologically defined sarcopenic and non-sarcopenic patient cohorts as per cross-sectional imaging skeletal muscle volumes.
Results: Thirteen studies met the inclusion criteria, of which all were retrospective cohort studies, which reported data representative of 2,211 patients undergoing resection and reconstruction for cancer of the head and neck. The prevalence of sarcopenia within the included cohorts ranged from 16% to 32%. Pre-operative sarcopenia was associated with significantly shortened overall survival [hazard ratio (HR) =2.53; 95% confidence interval (CI): 1.67, 3.84; P<0.05] and disease-free survival (HR =2.35; 95% CI: 1.48, 3.73; P<0.05). Clavien-Dindo grades 3–5 complications occurred more frequently among sarcopenic patients, with sarcopenic patients more likely to require blood transfusion in the perioperative period. Sarcopenia was further associated with poor treatment tolerance and delays to initiation of adjuvant therapies.
Conclusions: The role of sarcopenia in head and neck reconstruction remains under-defined. There are strong associations between reduced skeletal muscle mass and associated decreases in overall survival and disease-free survival. The current literature-base suggests that perioperative complications are more prevalent among sarcopenic cohorts, with these patients demonstrating inferior tolerance to adjuvant therapies.
Keywords: Free flap; head and neck cancer; head and neck reconstruction; sarcopenia; skeletal muscle mass
Acknowledgments
None.
Funding: None.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/map-26-ab174
Cite this abstract as: Coyle A, Hehir C, Lalor L, Dowling G, Smyth N, Martin-Smith J, O’Sullivan B, Dolan R. AB174. SOH26AB_0327. Pre-operative sarcopenia in head and neck reconstruction—implications for survival and perioperative complication rates: a meta-analysis. Mesentery Peritoneum 2026;10:AB174.
