CT-Defined Low Skeletal Muscle Mass Predicts Early Swallowing and Quality-of-Life Recovery After Head-and-Neck Oncologic Reconstruction

Sonia Roxana Burtic; Bogdan Florin Capastraru; Panche Taskov; Tudorel Mihoc; Daian Ionel Popa; Codrina Mihaela Levai; Daniel-Laurentiu Pop; Cosmin Rosca; Loredana Daneasa; Adelina Maria Jianu

doi:10.3390/diagnostics16071028

CT-Defined Low Skeletal Muscle Mass Predicts Early Swallowing and Quality-of-Life Recovery After Head-and-Neck Oncologic Reconstruction

Diagnostics (Basel). 2026 Mar 30;16(7):1028. doi: 10.3390/diagnostics16071028.

Authors

Sonia Roxana Burtic^{1

2

3}, Bogdan Florin Capastraru^{1

3

4}, Panche Taskov⁵, Tudorel Mihoc⁶, Daian Ionel Popa^{2

3}, Codrina Mihaela Levai^{2

3}, Daniel-Laurentiu Pop^{1

2}, Cosmin Rosca⁷, Loredana Daneasa⁸, Adelina Maria Jianu⁹

Affiliations

¹ Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
² Discipline of Medical Communications, Department II Microscopic Morphology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
³ Research Center for Medical Communication, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
⁴ Department XV, Discipline of Orthopedics-Trauma I, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
⁵ Discipline of Plastic and Reconstructive Surgery, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
⁶ Department X, General Surgery II, Discipline of Surgical Emergencies, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
⁷ Oculens Clinic, Calea Turzii, No. 134-136, 400501 Cluj-Napoca, Romania.
⁸ Olariu Med Clinic, Piata Petru Rares 1, 300094 Timisoara, Romania.
⁹ Department of Anatomy and Embryology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.

Abstract

Background and objectives: Early recovery after major head-and-neck reconstruction is shaped by nutritional vulnerability and functional decline. We evaluated whether preoperative CT-defined low skeletal muscle mass-considered here as an imaging-derived muscle-depletion phenotype rather than the full consensus syndrome of sarcopenia-predicts swallowing milestones, weight trajectory, and patient-reported outcomes at 12 weeks. Methods: In a prospective longitudinal cohort of 74 adults undergoing oncologic resection with reconstruction, low skeletal muscle mass was derived from preoperative cervical CT-based skeletal muscle measurements and nutritional risk was screened with NRS-2002. Outcomes included FOIS, PEG dependence, percent weight loss, MDADI, and European Organisation for Research and Treatment of Cancer QLQ-C30/QLQ-H&N35 at 12 weeks. A multivariable logistic regression explored a composite poor-recovery endpoint (PEG at 12 weeks and/or FOIS ≤ 3 and/or MDADI < 55). Results: Low skeletal muscle mass (32/74, 43.2%) was associated with longer length of stay (13.4 ± 4.1 vs. 10.3 ± 3.3 days; p < 0.001) and more major complications (31.2% vs. 11.9%; p = 0.04). At 12 weeks, affected patients had greater weight loss (10.9 ± 3.4% vs. 8.6 ± 2.6%; p = 0.003), lower FOIS (3.9 ± 1.1 vs. 4.6 ± 1.1; p = 0.01), lower MDADI (57.1 ± 10.9 vs. 66.6 ± 11.9; p = 0.001), and higher PEG dependence (31.2% vs. 9.5%; p = 0.018). Low skeletal muscle mass remained associated with poor recovery after adjustment (aOR 5.4; 95% CI 1.4-24.0; p = 0.016); adjuvant radiotherapy was also associated (aOR 4.3; p = 0.049). Model discrimination was good (AUC 0.81). Conclusions: Preoperative CT-defined low skeletal muscle mass was associated with impaired early recovery after major head-and-neck reconstruction, particularly when adjuvant radiotherapy was anticipated; however, these findings should be interpreted as exploratory and hypothesis-generating.

Keywords: deglutition disorders; head and neck neoplasms; low skeletal muscle mass; nutritional status; quality of life.