Supplementary Material for: Feasibility of colorectal endoscopic submucosal dissection in elderly patients: the impact of sarcopenia

Introduction: Colorectal cancer (CRC) is a public health concern associated with high incidence rates. Sarcopenia is a known risk factor for postoperative complications, although an association between increased complications after colorectal endoscopic submucosal dissection (ESD) and sarcopenia remains undocumented. Herein, we aimed to explore the feasibility of colorectal ESD in patients with sarcopenia.
Methods: This retrospective study included 499 patients (69 with and 430 without sarcopenia). We evaluated the short- and long-term outcomes of colorectal ESD.
Results: There were no significant differences between the two groups regarding en bloc, R0, or curative resection rates. However, poor bowel preparation was significantly more common in the sarcopenia group. Moreover, patients with sarcopenia exhibited a significant increase in complications (37.7% vs. 10.5%). Multivariate analysis revealed that sarcopenia (odds ratio [OR] 3.78, 95% confidence interval [Cl] 1.85–7.73, p < 0.001), anticoagulation therapy (OR 3.59, 95% Cl 1.86–6.92, p < 0.001), procedure time (OR 1.28, 95% Cl 1.11–1.47, p < 0.001), and resection size (OR 1.25, 95% Cl 1.03–1.52, p = 0.02) were significantly correlated with Common Terminology Criteria for Adverse Events (CTCAE) ≥ grade 2. The correlation between sarcopenia and CTCAE ≥ grade 2 was maintained after matching, resulting in more extended hospital stays in patients with sarcopenia. However, we detected no association between sarcopenia and overall survival and ESD-related death.
Conclusion: Sarcopenia is a risk factor for complications in colorectal ESD, suggesting that colorectal ESD could be performed for patients with sarcopenia, although much caution should be taken.

引言：结直肠癌（colorectal cancer, CRC）是一类发病率较高的公共卫生问题。肌肉减少症是术后并发症的已知危险因素，但结直肠内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）术后并发症增多与肌肉减少症之间的关联尚未见报道。本研究旨在探讨肌肉减少症患者接受结直肠ESD治疗的可行性。
方法：本回顾性研究共纳入499例患者，其中69例合并肌肉减少症，430例无肌肉减少症。本研究评估了结直肠ESD的短期与长期临床结局。
结果：两组患者的整块切除率、R0切除率及根治性切除率均无显著差异。但肌肉减少症组患者肠道准备不佳的比例显著更高。此外，肌肉减少症患者的并发症发生率显著升高（37.7% vs. 10.5%）。多因素分析显示，肌肉减少症（比值比[OR] 3.78，95%置信区间[CI] 1.85–7.73，p < 0.001）、抗凝治疗（OR 3.59，95% CI 1.86–6.92，p < 0.001）、操作时长（OR 1.28，95% CI 1.11–1.47，p < 0.001）以及切除病灶大小（OR 1.25，95% CI 1.03–1.52，p = 0.02）均与不良事件通用术语标准（Common Terminology Criteria for Adverse Events, CTCAE）≥2级不良反应显著相关。经匹配后，肌肉减少症与CTCAE≥2级不良反应的关联仍保持显著，且肌肉减少症患者的住院时长显著延长。但本研究未发现肌肉减少症与总生存期及ESD相关死亡存在关联。
结论：肌肉减少症是结直肠ESD术后并发症的危险因素，提示尽管需格外谨慎，但仍可对肌肉减少症患者实施结直肠ESD治疗。