Bioelectrical Impedance Analysis for Perioperative Fluid Evaluation in Colorectal Cancer Surgery

Overview

Sarcopenia is a complex syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. In patients with cancer, sarcopenia is associated with poorer prognosis, increased treatment-related toxicity, higher postoperative complication rates, reduced response to therapy, and decreased quality of life. Importantly, sarcopenia may be present even in patients with preserved nutritional status or overweight. Patients with gastrointestinal cancers are at particularly high risk of developing sarcopenia, both as a consequence of the malignant disease itself and as a result of systemic anticancer treatment. Early identification of patients at risk is therefore essential in order to enable timely nutritional and supportive interventions. The aim of this study is to evaluate the proportion of patients with gastrointestinal cancer who screen positive for sarcopenia risk using the SARC-F questionnaire before the start of systemic treatment and during treatment. Patients with a positive screening result will be referred for further clinical nutritional assessment and managed according to a multidisciplinary approach.

Sarcopenia is recognized as an important negative prognostic factor in oncology, independent of malnutrition. It contributes to increased morbidity and mortality, higher incidence of treatment-related toxicity, reduced tolerance to systemic therapy, and impaired functional status. In patients with gastrointestinal malignancies, sarcopenia is common due to tumor-related metabolic changes, reduced intake, inflammation, and the adverse effects of anticancer therapies. The SARC-F questionnaire is a simple, validated screening tool recommended by the European Working Group on Sarcopenia in Older People (EWGSOP2) for the identification of individuals at risk of sarcopenia. It consists of short, function-oriented questions assessing strength, assistance in walking, rising from a chair, climbing stairs, and falls. A SARC-F score of ≥4 indicates increased risk of sarcopenia. This prospective interventional study will include adult patients with gastrointestinal cancer who are candidates for systemic anticancer treatment. Participants will complete the SARC-F questionnaire at baseline, prior to initiation of systemic therapy, and again during treatment. The primary objective is to determine the proportion of patients with positive SARC-F screening results at these time points and to evaluate changes in sarcopenia risk during the course of treatment. Patients who screen positive for sarcopenia risk will be referred to the clinical nutrition outpatient clinic for further assessment, including anthropometric measurements and, where clinically indicated, dual-energy X-ray absorptiometry (DXA). Based on the results, individualized multimodal interventions for the prevention and treatment of sarcopenia will be initiated in collaboration with a multidisciplinary team. The study does not impose additional diagnostic or therapeutic burden beyond standard clinical care. The results are expected to contribute to improved early identification and management of sarcopenia in patients with gastrointestinal cancer.