Li ZW, Liu Z, Liu SQ. Muscle mass correlates with rocuronium distribution volume and guides dose optimization in obese colorectal cancer patients. World J Gastrointest Oncol 2026; 18(1): 112742 [DOI: 10.4251/wjgo.v18.i1.112742]
Corresponding Author of This Article
Sheng-Qun Liu, MSc, Chief Physician, Department of Anesthesia and Perioperative Medicine, Henan Provincial People’s Hospital (Zhengzhou University People’s Hospital), No. 7 Weiwu Road, Zhengzhou 450003, Henan Province, China. liushengqunhx@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 15, 2026 (publication date) through Jan 12, 2026
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Oncology
ISSN
1948-5204
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Li ZW, Liu Z, Liu SQ. Muscle mass correlates with rocuronium distribution volume and guides dose optimization in obese colorectal cancer patients. World J Gastrointest Oncol 2026; 18(1): 112742 [DOI: 10.4251/wjgo.v18.i1.112742]
World J Gastrointest Oncol. Jan 15, 2026; 18(1): 112742 Published online Jan 15, 2026. doi: 10.4251/wjgo.v18.i1.112742
Muscle mass correlates with rocuronium distribution volume and guides dose optimization in obese colorectal cancer patients
Zhan-Wen Li, Zhe Liu, Sheng-Qun Liu
Zhan-Wen Li, Zhe Liu, Sheng-Qun Liu, Department of Anesthesia and Perioperative Medicine, Henan Provincial People’s Hospital (Zhengzhou University People’s Hospital), Zhengzhou 450003, Henan Province, China
Author contributions: Li ZW was responsible for study conception, data collection, bioelectrical impedance analysis, statistical modeling, and manuscript drafting; Liu Z was responsible for methodology development, anesthesia management, clinical data collection, and manuscript revision; Liu SQ was responsible for study supervision, overall design, data interpretation, and corresponding author responsibilities; and all authors contributed to manuscript revision and approved the final version.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Henan Provincial People’s Hospital, approval No. (2021) Ethics Review 160.
Informed consent statement: Informed consent was waived due to the retrospective design and use of de-identified data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: De-identified data underlying the findings of this study are available from the corresponding author on reasonable request and subject to institutional approval.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Qun Liu, MSc, Chief Physician, Department of Anesthesia and Perioperative Medicine, Henan Provincial People’s Hospital (Zhengzhou University People’s Hospital), No. 7 Weiwu Road, Zhengzhou 450003, Henan Province, China. liushengqunhx@163.com
Received: August 15, 2025 Revised: September 22, 2025 Accepted: December 2, 2025 Published online: January 15, 2026 Processing time: 150 Days and 2.4 Hours
Abstract
BACKGROUND
Perioperative anesthesia management of obese patients presents significant challenges as traditional total body weight-based dosing fails to achieve optimal anesthetic effects due to altered pharmacokinetic characteristics including abnormal drug distribution and clearance. Rocuronium exhibits markedly different distribution patterns in obese patients, with conventional weight correction methods inadequately addressing individual muscle mass variations that critically influence drug distribution.
AIM
To investigate the quantitative relationship between skeletal muscle index (SMI) and rocuronium distribution volume in obese colorectal cancer patients, establish a population pharmacokinetic model, and develop individualized dosing strategies based on muscle mass.
METHODS
A retrospective cohort study was conducted, including 100 obese patients (body mass index ≥ 30 kg/m2) who underwent elective radical colorectal cancer surgery at our hospital from June 2023 to January 2025. Skeletal muscle mass was measured using InBody260 body composition analyzer and SMI was calculated to assess muscle mass, with male SMI < 7.0 kg/m2 and female SMI < 5.7 kg/m2 as diagnostic criteria for sarcopenia. Plasma rocuronium concentrations were detected by liquid chromatography-tandem mass spectrometry/mass spectrometry, and nonlinear mixed-effect modeling was used to establish population pharmacokinetic modeling. Stepwise regression was used to screen covariates, and dosing regimens were optimized through Monte Carlo simulation. The primary endpoint was targeted plasma concentration achievement rate, and the secondary endpoint was postoperative residual muscle relaxation incidence.
RESULTS
Among 100 patients, 35 (35.0%) had sarcopenia and 65 (65.0%) did not. Patients in the sarcopenia group were older (64.1 ± 9.8 years vs 54.2 ± 10.9 years, P < 0.001) and had significantly lower SMI (6.2 ± 0.8 kg/m2 vs 8.4 ± 1.2 kg/m2, P < 0.001). SMI showed strong positive correlation with rocuronium steady-state distribution volume (r = 0.718, P < 0.001) and moderate negative correlation with clearance (r = -0.502, P < 0.001). A two-compartment population pharmacokinetic model was successfully established, with SMI being the most important covariate affecting central compartment distribution volume (△OFV = -41.2, P < 0.001). Model validation showed bootstrap successful convergence rate of 92.3%, and 92.1% of observed values fell within prediction intervals in predicted concentration versus predicted concentration. The SMI-based individualized dosing regimen improved target exposure achievement rate from 82.0% in traditional regimen to 93.5% (P = 0.009), and reduced postoperative residual muscle relaxation incidence from 13.0% to 3.5% (P = 0.018). The sarcopenia group showed the most significant improvement in achievement rate, from 71.4% to 93.8% (P = 0.017).
CONCLUSION
SMI shows strong correlation with rocuronium distribution volume in obese colorectal cancer patients and is a key factor affecting drug distribution. SMI-based individualized dosing strategies can significantly improve target exposure achievement rate and reduce postoperative residual muscle relaxation incidence, providing scientific evidence for precision anesthesia management in obese patients.
Core Tip: This study established a population pharmacokinetic model of rocuronium in obese patients with colorectal cancer, incorporating skeletal muscle index to explore its effect on drug distribution volume. Using nonlinear mixed-effects modeling and Monte Carlo simulation, we developed an individualized dosing strategy based on muscle mass. The findings reveal that skeletal muscle index is a significant covariate influencing rocuronium pharmacokinetic, providing a scientific basis for optimizing anesthetic dosing in obese surgical patients and enhancing patient safety during colorectal cancer surgery.
