{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:00:59Z","timestamp":1790834459227,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sarcopenia, defined as loss of muscle mass and function, has been identified as a negative prognostic factor in outcomes of major abdominal cancer operations. We sought to understand the impact of sarcopenia, using the psoas muscle index (PMI) as a surrogate, during neoadjuvant radiation (NR) on perioperative outcomes in patients with retroperitoneal sarcoma (RPS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We performed a single\u2010institution retrospective review of patients with RPS undergoing resection between 2017 and 2024. Data were extracted for patient demographics, details of NR, surgical resection, length of stay (LOS), and 30\u2010day postoperative complications (Clavien\u2010Dindo Scale). PMI was defined as total psoas muscle area at the 3rd lumbar vertebrae divided by height squared, measured on preoperative imaging. PMI was stratified by quartile, and patients were evaluated for PMI loss during NR. Data were analyzed using Chi\u2010square\/Fisher's exact test for categorical variables, Student\n                      <jats:italic>t<\/jats:italic>\n                      \u2010test\/one\u2010way ANOVA for continuous variables. Logistic regression model was built by backward elimination.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 163 patients who underwent resection for RPS following NR and 51 of these had pre\u2010 and post\u2010NR images available for review. Patients were 52.2% male, and 42.2% had at least one comorbidity (HTN, DM, or coronary artery disease). Subtype diagnoses included dedifferentiated liposarcoma (36.8%), well\u2010differentiated liposarcoma (27.0%), leiomyosarcoma (18.4%), and other (17.8%). Lowest quartile PMI patients were older (71.2 vs. 59.5 years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) than highest quartile PMI patients, without differences in comorbidity rates (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.747). Patients with PMI loss during NR did not have more (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.291) or worse (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.490) 30\u2010day complications; however, after adjusting for covariates, lowest quartile PMI patients had significantly longer hospital LOS (8.8 vs. 6.4 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048) compared to those in the highest quartile.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with RPS, sarcopenia is associated with longer hospital LOS. Loss of PMI during NR is an objective measure of poor radiation tolerance and is an independent variable that stratifies those at risk for a prolonged postoperative course. Prospective calculation of preoperative PMI can inform a targeted prehabilitation program or stratified ERAS pathways. Validation of these findings with larger, multi\u2010institutional studies may significantly impact the perioperative cost of care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70412","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:40:38Z","timestamp":1790833238000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sarcopenia After Neoadjuvant Radiation Is Associated With Increased Length of Stay Following Resection of Retroperitoneal Sarcoma"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3816-3003","authenticated-orcid":false,"given":"Leah E.","family":"Hendrick","sequence":"first","affiliation":[{"name":"Sarcoma Department H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4975-5140","authenticated-orcid":false,"given":"Jae Hwan","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Surgery University of South Florida Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0115-2765","authenticated-orcid":false,"given":"Rikesh J.","family":"Makanji","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5110-8412","authenticated-orcid":false,"given":"Rachel K.","family":"Voss","sequence":"additional","affiliation":[{"name":"Sarcoma Department H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo J.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Sarcoma Department H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9596-6785","authenticated-orcid":false,"given":"John E.","family":"Mullinax","sequence":"additional","affiliation":[{"name":"Sarcoma Department H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA"},{"name":"Department of Surgery University of South Florida Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12113409"},{"issue":"9","key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/j.injury.2019.07.001","article-title":"The Impact of Computed Tomography\u2010Assessed Sarcopenia on Outcomes for Trauma Patients\u2014A Systematic Review and Meta\u2010Analysis","volume":"50","author":"Xia W.","year":"2019","journal-title":"Injury"},{"issue":"5","key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1097\/MEG.0000000000001552","article-title":"Sarcopenia as Prognostic Factor for Survival After Orthotopic Liver Transplantation","volume":"32","author":"Pinto Dos Santos D.","year":"2020","journal-title":"European Journal of Gastroenterology & Hepatology"},{"issue":"5","key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.ejso.2018.09.026","article-title":"Sarcopenia is an Independent Unfavorable Prognostic Factor of Non\u2010Small Cell Lung Cancer After Surgical Resection: A Comprehensive Systematic Review and Meta\u2010Analysis","volume":"45","author":"Deng H. Y.","year":"2019","journal-title":"European Journal of Surgical Oncology"},{"issue":"6","key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1038\/bjc.2012.350","article-title":"Sarcopenia is Associated With Postoperative Infection and Delayed Recovery From Colorectal Cancer Resection Surgery","volume":"107","author":"Lieffers J. R.","year":"2012","journal-title":"British Journal of Cancer"},{"issue":"3","key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s00520-014-2418-6","article-title":"Effect of Muscle Mass on Toxicity and Survival in Patients With Colon Cancer Undergoing Adjuvant Chemotherapy","volume":"23","author":"Jung H. W.","year":"2015","journal-title":"Supportive Care in Cancer"},{"issue":"1","key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s40644-019-0270-0","article-title":"CT\u2010Assessed Sarcopenia Is a Predictive Factor for Both Long\u2010Term and Short\u2010Term Outcomes in Gastrointestinal Oncology Patients: A Systematic Review and Meta\u2010Analysis","volume":"19","author":"Su H.","year":"2019","journal-title":"Cancer Imaging: The Official Publication of the International Cancer Imaging Society"},{"issue":"1","key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1159\/000494887","article-title":"Computed Tomography\u2010Assessed Sarcopenia Indexes Predict Major Complications Following Surgery for Hepatopancreatobiliary Malignancy: A Meta\u2010Analysis","volume":"74","author":"Cao Q.","year":"2019","journal-title":"Annals of Nutrition and Metabolism"},{"issue":"3","key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1007\/s11605-017-3362-9","article-title":"Quantitative Assessment of Visceral Obesity and Postoperative Colon Cancer Outcomes","volume":"21","author":"Ozoya O. O.","year":"2017","journal-title":"Journal of Gastrointestinal Surgery"},{"issue":"11","key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.5551\/jat.12963","article-title":"Reduction of Visceral Fat Correlates With the Decrease in the Number of Obesity\u2010Related Cardiovascular Risk Factors in Japanese With Abdominal Obesity (VACATION\u2010J Study)","volume":"19","author":"Hiuge\u2010Shimizu A.","year":"2012","journal-title":"Journal of Atherosclerosis and Thrombosis"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jss.2018.11.027","article-title":"Semiautomated Measure of Abdominal Adiposity Using Computed Tomography Scan Analysis","volume":"237","author":"Srikumar T.","year":"2019","journal-title":"Journal of Surgical Research"},{"issue":"9","key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"2669","DOI":"10.1245\/s10434-018-6652-x","article-title":"Assessment of Computed Tomography (CT)\u2010Defined Muscle and Adipose Tissue Features in Relation to Short\u2010Term Outcomes After Elective Surgery for Colorectal Cancer: A Multicenter Approach","volume":"25","author":"Martin L.","year":"2018","journal-title":"Annals of Surgical Oncology"},{"issue":"6","key":"e_1_2_7_14_1","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1016\/j.jamcollsurg.2013.01.007","article-title":"Quantitative Measures of Visceral Adiposity and Body Mass Index in Predicting Rectal Cancer Outcomes After Neoadjuvant Chemoradiation","volume":"216","author":"Clark W.","year":"2013","journal-title":"Journal of the American College of Surgeons"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-022-11944-z"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12805"},{"issue":"2","key":"e_1_2_7_17_1","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey","volume":"240","author":"Dindo D.","year":"2004","journal-title":"Annals of Surgery"},{"issue":"2","key":"e_1_2_7_18_1","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jamcollsurg.2010.03.039","article-title":"Sarcopenia and Mortality After Liver Transplantation","volume":"211","author":"Englesbe M. J.","year":"2010","journal-title":"Journal of the American College of Surgeons"},{"issue":"4","key":"e_1_2_7_19_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0195406","article-title":"Skeletal Muscle Loss is an Independent Negative Prognostic Factor in Patients With Advanced Lower Rectal Cancer Treated With Neoadjuvant Chemoradiotherapy","volume":"13","author":"Takeda Y.","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"e_1_2_7_20_1","doi-asserted-by":"crossref","first-page":"110","DOI":"10.2478\/raon-2024-0013","article-title":"Influence of Nutritional Status and Body Composition on Postoperative Events and Outcome in Patients Treated for Primary Localized Retroperitoneal Sarcoma","volume":"58","author":"Ramanovic M.","year":"2024","journal-title":"Radiology and Oncology"},{"issue":"5","key":"e_1_2_7_21_1","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1002\/jso.27199","article-title":"Sarcopenia and Frailty as Predictors of Surgical Morbidity and Oncologic Outcomes in Retroperitoneal Sarcoma","volume":"127","author":"Nasirishargh A.","year":"2023","journal-title":"Journal of Surgical Oncology"},{"issue":"5","key":"e_1_2_7_22_1","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.3390\/nu12051293","article-title":"Sarcopenia: A Contemporary Health Problem Among Older Adult Populations","volume":"12","author":"Papadopoulou S.","year":"2020","journal-title":"Nutrients"},{"issue":"11","key":"e_1_2_7_23_1","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1249\/MSS.0000000000000975","article-title":"Disease\u2010Induced Skeletal Muscle Atrophy and Fatigue","volume":"48","author":"Powers S. 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L.","year":"2023","journal-title":"Journal of Clinical Medicine"},{"issue":"5","key":"e_1_2_7_26_1","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1210\/clinem\/dgab884","article-title":"Prevalence and Risk Factors of Sarcopenia in Patients With Diabetes: A Meta\u2010Analysis","volume":"107","author":"Feng L.","year":"2022","journal-title":"Journal of Clinical Endocrinology & Metabolism"},{"issue":"9","key":"e_1_2_7_27_1","first-page":"1838","article-title":"Evaluation of the Effects of Radiation Therapy on Muscle Contractibility and Skin Healing: An Experimental Study of the Cancer Treatment Implications","volume":"13","author":"Avelino S. O. M.","year":"2023","journal-title":"Life (Basel)"},{"issue":"14","key":"e_1_2_7_28_1","doi-asserted-by":"crossref","first-page":"2796","DOI":"10.1002\/cncr.34239","article-title":"Critical Impact of Radiotherapy Protocol Compliance and Quality in the Treatment of Retroperitoneal Sarcomas: Results From the EORTC 62092\u201022092 STRASS Trial","volume":"128","author":"Haas R.","year":"2022","journal-title":"Cancer"},{"issue":"7","key":"e_1_2_7_29_1","doi-asserted-by":"crossref","first-page":"2721","DOI":"10.3390\/s22072721","article-title":"Comparative Analysis of Supervised Classifiers for the Evaluation of Sarcopenia Using a sEMG\u2010Based Platform","volume":"22","author":"Leone A.","year":"2022","journal-title":"Sensors"},{"issue":"2","key":"e_1_2_7_30_1","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afac003","article-title":"Resistance Exercise as a Treatment for Sarcopenia: Prescription and Delivery","volume":"51","author":"Hurst C.","year":"2022","journal-title":"Age and Ageing"},{"issue":"1","key":"e_1_2_7_31_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5534\/wjmh.200190","article-title":"Rehabilitation Nutrition and Exercise Therapy for Sarcopenia","volume":"40","author":"Kakehi S.","year":"2022","journal-title":"World Journal of Men's Health"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70412","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.70412","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70412","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:40:42Z","timestamp":1790833242000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70412"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":30,"alternative-id":["10.1002\/jso.70412"],"URL":"https:\/\/doi.org\/10.1002\/jso.70412","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"assertion":[{"value":"2026-03-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jso.70412"}}