Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Gastroenterology, Research Center for Hepatitis and Immunology, Research Institute, National Center for Global Health and Medicine, Chiba, Japan.
Dis Esophagus. 2019 Mar 1;32(3). doi: 10.1093/dote/doy092.
Surgery for esophageal carcinoma is known to be associated with high morbidity. Recent studies have reported a correlation of nutritional and inflammatory parameters with postoperative course. This study aims to clarify the risk factors for operative morbidity after resection of esophageal carcinoma. Consecutive patients who underwent esophagectomy for esophageal squamous cell carcinoma at our institute were included (n = 102; 89 males and 13 females; mean age: 67.3 years). Clinicopathological characteristics, presence or absence of sarcopenia, and modified Glasgow prognostic score were assessed, and their correlation with postoperative complications was investigated using univariate and multivariate analyses. Sarcopenia was defined using a combination of muscle mass area and body mass index. Of the included 102 patients, 45 (44.1%) exhibited sarcopenia (sarcopenia group), while 57 (55.9%) did not (non-sarcopenia group). No significant difference was observed between the groups regarding surgical procedures and tumor stage; furthermore, there was no mortality. Twenty-six patients developed respiratory complications (including 20 cases of pneumonia). On univariate analysis, sarcopenia, modified Glasgow prognostic score, and American Society of Anesthesiologists physical status were found to be significantly associated with the development of postoperative respiratory complications. On multivariate analysis, sarcopenia was found to be an independent risk factor for postoperative respiratory complications after esophagectomy. We believe that identifying patients at risk and providing preoperative nutritional support as well as physical therapy aimed at strengthening of body muscles may help reduce the incidence of postoperative respiratory complications in such patients.
食管癌的手术与高发病率有关。最近的研究报告了营养和炎症参数与术后过程的相关性。本研究旨在阐明食管癌切除术后手术发病率的危险因素。本研究纳入了在我院接受食管癌切除术的连续患者（n=102；89 名男性和 13 名女性；平均年龄：67.3 岁）。评估了临床病理特征、是否存在肌肉减少症和改良格拉斯哥预后评分，并使用单因素和多因素分析研究了它们与术后并发症的相关性。肌肉减少症采用肌肉质量面积和体重指数的组合来定义。在纳入的 102 例患者中，45 例（44.1%）存在肌肉减少症（肌肉减少症组），57 例（55.9%）不存在（非肌肉减少症组）。两组在手术程序和肿瘤分期方面没有差异；此外，没有死亡病例。26 例患者发生呼吸并发症（包括 20 例肺炎）。单因素分析发现，肌肉减少症、改良格拉斯哥预后评分和美国麻醉医师协会身体状况与术后呼吸并发症的发生显著相关。多因素分析发现，肌肉减少症是食管癌手术后发生术后呼吸并发症的独立危险因素。我们认为，识别有风险的患者并提供术前营养支持以及旨在增强身体肌肉力量的物理治疗，可能有助于降低此类患者术后呼吸并发症的发生率。
