(PM P2) Association of Muscle Quantity and Frailty on Short-term Outcomes of CRS/HIPEC in Patients with Appendiceal Cancer

Introduction: Sarcopenia and frailty are associated with inferior outcomes in several disease states. The impact of muscle quantity and frailty on CRS/HIPEC outcomes are not well-defined.

Methods: A single-center retrospective analysis of a prospectively-maintained database was conducted to evaluate impact of muscle quantity on post-operative outcomes of CRS/HIPEC in patients with appendiceal cancer. Psoas muscle Index (PMI) was calculated as height-adjusted sum of right and left psoas cross-sectional area. 5-point modified frailty index (mFI-5) was calculated using preoperative clinical variables. Primary outcome was association between PMI and post-operative complications.

Results: One-hundred six patients underwent 121 distinct procedures. Median age was 56.9 [IQR 50.6-65.8], 59.4% (N=63) were female and 20.8% (N=22) underwent repeat procedures. Median PMI was 912.4 [IQR 712.7-1162.2], PCI was 19 [IQR 8.50-30.75] and 83% (n=83 of 100) were CC0/1 resections. Median LOS was 9 days [IQR 8-12], and 30% (N=37) required postoperative ICU admission. Major morbidity rate was 28% (n=34) for early and 9.9% for delayed (30-90 day) complications. 30-day readmission-rate was 7%. mFI or PMI were not associated with 30- or 90-day major morbidity. While PMI was associated with LOS and postoperative ICU admission, this effect was not maintained on MV analysis (Table). EBL was the only factor independently associated with LOS and ICU admission.

Conclusions: PMI and mFI-5 did not independently predict post-operative outcomes in a highly-selected single-center patient cohort undergoing CRS/HIPEC for appendiceal cancer. This data however, establishes feasibility in measuring PMI in this population and warrants longitudinal outcome evaluation as a means to preoperative counseling, setting postoperative expectations and instituting appropriate pre-habilitation strategies.