Makiura Daisuke, Ono Rei, Inoue Junichiro, Kashiwa Miyuki, Oshikiri Taro, Nakamura Tetsu, Kakeji Yoshihiro, Sakai Yoshitada, Miura Yasushi
Division of Rehabilitation, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan; Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe 654-0142, Hyogo, Japan.
Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe 654-0142, Hyogo, Japan.
J Geriatr Oncol. 2016 Nov;7(6):430-436. doi: 10.1016/j.jgo.2016.07.003. Epub 2016 Jul 21.
The number of geriatric patients with esophageal cancer has been increasing. Geriatric syndromes such as sarcopenia might adversely affect postoperative recovery. The aim of this study was to evaluate the relationships between sarcopenia and postoperative complications, and the associations between sarcopenia and perioperative functional changes in patients with esophageal cancer following esophagectomy.
Participants comprised 104 patients who underwent esophagectomy from July 2011 to April 2015. Preoperative sarcopenia was diagnosed by the presence of low muscle mass and low physical functions according to Asian Working Group for Sarcopenia criteria. Low physical function was defined by loss of grip strength and/or slow walking speed. Postoperative pulmonary, cardiac, infectious, and surgical complications were extracted. Perioperative functional changes were calculated (value at postoperative day 30-value before surgery). For statistical analyses, both uni- and multivariate logistic regression analyses were performed.
Twenty-nine patients (27.9%) were diagnosed with sarcopenia. The incidence of postoperative pulmonary complications was significantly higher in the sarcopenia group (37.9%) than in the non-sarcopenia group (17.3%; P=0.04). There was no relationship between sarcopenia and other complications or perioperative functional changes. Multivariate analysis identified sarcopenia (odds ratio (OR), 3.13; 95% confidence interval (CI), 1.12-8.93) and high Brinkman index (OR, 3.46; 95% CI, 1.20-11.77) as independent risk factors for the development of pulmonary complications.
The assessment of sarcopenia may be useful to predict the postoperative pulmonary complications following esophagectomy. On the other hand, sarcopenia does not predict cardiac, infectious, and surgical complications or perioperative function.
老年食管癌患者数量一直在增加。肌肉减少症等老年综合征可能会对术后恢复产生不利影响。本研究的目的是评估肌肉减少症与术后并发症之间的关系，以及肌肉减少症与食管癌患者食管切除术后围手术期功能变化之间的关联。
研究对象为2011年7月至2015年4月期间接受食管切除术的104例患者。根据亚洲肌肉减少症工作组的标准，术前肌肉减少症通过低肌肉量和低身体功能来诊断。低身体功能由握力丧失和/或步行速度缓慢来定义。提取术后肺部、心脏、感染和手术并发症。计算围手术期功能变化（术后第30天的值-术前值）。进行统计分析时，采用单因素和多因素逻辑回归分析。
29例患者（27.9%）被诊断为肌肉减少症。肌肉减少症组术后肺部并发症的发生率（37.9%）显著高于非肌肉减少症组（17.3%；P=0.04）。肌肉减少症与其他并发症或围手术期功能变化之间没有关系。多因素分析确定肌肉减少症（比值比（OR），3.13；95%置信区间（CI），1.12-8.93）和高布林克曼指数（OR，3.46；95%CI，1.20-11.77）是发生肺部并发症的独立危险因素。
评估肌肉减少症可能有助于预测食管切除术后的肺部并发症。另一方面，肌肉减少症不能预测心脏、感染和手术并发症或围手术期功能。
