Annals of Coloproctology

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Diagnostic performance of various radiological modalities in the detection of sarcopenia within Asian populations: a systematic review: Shi Wei Ang, Jacqueline Liew, Vanessa Malishree Dharmaratnam, Vanessa Yi Jean Yik, Shawn Kok, Syed Aftab, Cherie Tong, Hui Bing Lee, Shimin Mah, Clement Yan, Bin-Tean Teh, Frederick H. Koh; Ann Coloproctol. 2025;41(1):27-39. Published online December 20, 2024; DOI: https://doi.org/10.3393/ac.2024.00080.0011

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Purpose
Diagnosing sarcopenia necessitates the measurement of skeletal muscle mass. However, guidelines lack a standardized imaging modality with thresholds validated among Asians. This systematic review compared ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and bioelectrical impedance analysis (BIA)/body composition monitoring in the detection of sarcopenia within Asian populations.
Methods
PubMed and Embase were systematically searched for studies analyzing ultrasonography, CT, MRI, and BIA in diagnosing sarcopenia among Asians. Study quality was assessed using the Newcastle-Ottawa scale.
Results
Pooled findings from 21,598 patients across 25 studies were examined. In receiver operating characteristic analysis, ultrasound displayed a pooled mean area under the curve (AUC) of 0.767 (95% confidence interval [CI], 0.709–0.806), with mean sensitivity of 81.1% (95% CI, 0.744–0.846) and specificity of 73.1% (95% CI, 0.648–0.774), for detecting sarcopenia in Asian populations. CT exhibited an AUC of 0.720 (sensitivity, 54.0%; specificity, 92.0%). MRI demonstrated an AUC of 0.839 (sensitivity, 67.0%; specificity, 66.0%). BIA displayed an AUC of 0.905 (95% CI, 0.842–0.968), 80.7% sensitivity (95% CI, 0.129–0.679), and 82.4% specificity (95% CI, 0.191–0.633).
Conclusion
Various modalities aid in diagnosing sarcopenia, and selection should be individualized. Although only BIA and dual-energy x-ray absorptiometry are recommended by the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People, ultrasound imaging may hold diagnostic value for sarcopenia in the Asian population. In certain groups, diagnostic use of CT and MRI is warranted. Future research can standardize and validate modality-specific thresholds and protocols within Asian populations.

Citations

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Developing a reliable and convenient methodology for ultrasound muscle assessment in critically ill patients: A reliability study
Yong Jae Na, Shin Who Park, Woo Jung Seo, Kyung Cheon Seo, Jong Yoon Chang, Hyo Jin Lim, Hyeon Jeong Moon, Roo Ma Lee, Eun Jae Ko, Sang-Bum Hong, Won Kim
Medicine.2025; 104(17): e42263. CrossRef

Original Article

Colorectal cancer

Computed tomography–assessed presarcopenia and clinical outcomes after laparoscopic surgery for rectal cancer: Ji Hyeong Song, Rak Kyun Oh, Jeong Eun Lee, Kyung Ha Lee, Ji Yeon Kim, Jin Soo Kim; Ann Coloproctol. 2023;39(6):513-520. Published online December 12, 2023; DOI: https://doi.org/10.3393/ac.2023.00031.0004

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Abstract PDF: Purpose
Previous studies have reported that presarcopenia negatively affects rectal cancer treatment. However, most studies have analyzed patients including majority of open surgery, and the association between presarcopenia and clinical outcomes after laparoscopic rectal cancer surgery remains unclear. This study aimed to evaluate the impact of presarcopenia on the clinical and oncological outcomes after laparoscopic rectal cancer surgery.
Methods
Three hundred and one patients undergoing laparoscopic rectal cancer surgery between December 2009 and May 2016 were enrolled. Body composition was assessed using computed tomography by measuring the muscle and fat areas at the third lumbar (L3) vertebra. The L3 skeletal muscle area was used to calculate the skeletal muscle index and evaluate presarcopenia.
Results
Presarcopenia was more common in older ( ≥ 70 years, P = 0.008) or female patients (P = 0.045). Patients with presarcopenia had decreased skeletal muscle area (P < 0.001), lower hemoglobin level (P = 0.034), longer time to first flatus (P < 0.001), and more frequent surgical site infection (P = 0.001). However, survival rates were not significantly different between those with and without presarcopenia.
Conclusion
Computed tomography-assessed presarcopenia was associated with delayed functional recovery and increased surgical site infection, although it was not revealed as a prognostic factor for oncological outcomes.

Review

Benign bowel disease

Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery: Jingting Wu, Hannah Chi, Shawn Kok, Jason M.W. Chua, Xi-Xiao Huang, Shipin Zhang, Shimin Mah, Li-Xin Foo, Hui-Yee Peh, Hui-Bing Lee, Phoebe Tay, Cherie Tong, Jasmine Ladlad, Cheryl H.M. Tan, Nathanelle Khoo, Darius Aw, Cheryl X.Z. Chong, Leonard M.L. Ho, Sharmini S. Sivarajah, Jialin Ng, Winson J.H. Tan, Fung-Joon Foo, Bin-Tean Teh, Frederick H. Koh; Ann Coloproctol. 2024;40(1):3-12. Published online March 31, 2023; DOI: https://doi.org/10.3393/ac.2022.01207.0172

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25 Web of Science
28 Citations

Abstract PDF

Sarcopenia, which is characterized by progressive and generalized loss of skeletal muscle mass and strength, has been well described to be associated with numerous poor postoperative outcomes, such as increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care, decreased functional outcome, and poorer oncological outcomes in cancer surgery. Multimodal prehabilitation, as a concept that involves boosting and optimizing the preoperative condition of a patient prior to the upcoming stressors of a surgical procedure, has the purported benefits of reversing the effects of sarcopenia, shortening hospitalization, improving the rate of return to bowel activity, reducing the costs of hospitalization, and improving quality of life. This review aims to present the current literature surrounding the concept of sarcopenia, its implications pertaining to colorectal cancer and surgery, a summary of studied multimodal prehabilitation interventions, and potential future advances in the management of sarcopenia.

Citations

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