Sarcopenia and Neuromuscular Block in Gastrointestinal Cancer Surgery

Sarcopenia, characterized by the loss of skeletal muscle mass and function, is a significant clinical parameter affecting both prognosis and perioperative management in patients with gastrointestinal (GI) cancer. It may alter the pharmacokinetic and pharmacodynamic properties of anesthetic agents, particularly neuromuscular blocking agents. This prospective observational study will be conducted at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital between June 1, 2025, and September 1, 2025.

Adult patients (aged 18 and above) scheduled for elective GI cancer surgery who have undergone preoperative abdominal computed tomography (CT) will be included. Patients with neuromuscular diseases, those on chronic steroid or immunosuppressive therapy, or those with significant organ failure will be excluded. Preoperative CT images at the L3 vertebral level will be evaluated by a radiologist to determine sarcopenia status, and patients will be divided into sarcopenic and non-sarcopenic groups according to established cut-off values.

All patients will receive standard anesthesia monitoring, including TOF (Train-of-Four) neuromuscular monitoring. The study will not alter any treatment protocols. After administration of muscle relaxants during anesthesia induction, neuromuscular block parameters such as onset time, depth, duration, need for reversal agents, and recovery time will be recorded. Demographic data, comorbidities, laboratory findings, type of surgery, and details of muscle relaxant use will also be collected.

The primary objective is to compare intraoperative neuromuscular block parameters between sarcopenic and non-sarcopenic patients. Statistical analysis will be performed using appropriate parametric or non-parametric tests for continuous variables and chi-square tests for categorical variables. The study aims to provide evidence for individualized dosing of muscle relaxants and to improve patient safety in anesthesia practice for GI cancer surgery.

Inclusion criteria

• Patients aged between 18 and 75 years
• Patients diagnosed with gastrointestinal system (GIS) cancer and scheduled for elective surgery
• Patients who have undergone preoperative abdominal computed tomography (CT) imaging
• Patients classified as American Society of Anesthesiologists (ASA) physical status I-III

Exclusion criteria

• Patients with a history of neuromuscular diseases
• Patients receiving chronic steroid or immunosuppressive therapy
• Patients with electrolyte imbalance
• Patients using medications that affect neuromuscular transmission
• Patients with severe organ failure in the preoperative period (e.g., liver or renal failure)
• Patients who refuse to participate in the study
• Patients requiring emergency surgery
• Patients using muscle relaxants in the preoperative period