The association between preoperative computed tomography -determined muscle characteristics and postoperative recovery in physical functioning and physical performance in patients undergoing gastrointestinal or lung cancer surgery

AIM: To investigate the association between preoperative computed tomography (CT) determined low muscle mass and low muscle quality (myosteatosis) on postoperative recovery in physical functioning and physical performance in patients undergoing gastrointestinal or lung cancer surgery. METHODS: A prospective cohort study was conducted using data from the Optimal Physical Recovery After Hospitalization (OPRAH) trial. The study population comprised adult patients scheduled for curative intent gastrointestinal or lung cancer surgery. Physical functioning (patient reported) and physical performance (handgrip strength, 30 s chair stand test, 2-min step test) were measured at multiple time points, up to three months after hospital discharge. Baseline CT scans were used to define low muscle mass and myosteatosis. Mixed-effect modeling evaluated associations between these muscle conditions and longitudinal postoperative recovery of physical functioning and physical performance. RESULTS: Of the 134 enrolled patients, 106 were included in the analysis. Preoperatively assessed low muscle mass was present in 28% of patients, myosteatosis in 58%, and both conditions in 22%. Patients with low muscle mass were younger than those with myosteatosis or with both conditions, but older than patients with adequate muscle status, and had a lower body mass index (BMI). Myosteatosis was more common in men and in patients with gastrointestinal tumors. Neither condition was associated with recovery of patient-reported physical functioning. However, both low muscle mass and myosteatosis were significantly associated with longitudinal outcome in the 30-s chair stand test, whereas no significant associations were observed for handgrip strength or the 2-min step test. Patients with adequate muscle status consistently performed better across all time points. CONCLUSION: CT-determined muscle characteristics were not associated with recovery in self-reported physical functioning. However, low muscle mass and myosteatosis were related to recovery of physical performance in the 30-s chair test. Preoperative muscle assessment using routine CT-imaging may therefore assist in identifying patients at risk of reduced postoperative physical performance and guide targeted prehabilitation strategies.