Xu Jinxin, Zheng Bin, Zhang Shuliang, Zeng Taidui, Chen Hao, Zheng Wei, Chen Chun
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
J Thorac Dis. 2019 Jun;11(6):2535-2545. doi: 10.21037/jtd.2019.05.55.
Sarcopenia is closely associated with surgical complications in patients with certain cancers. In this study we assessed the relationship between sarcopenia and postoperative complications in patients with oesophageal squamous cell carcinoma.
We retrospectively analysed of patients who underwent thoracoscopic combined with laparoscopic radical resection of oesophageal cancer. Preoperative computed tomography to evaluate skeletal muscle mass to diagnose sarcopenia and to evaluate associations with age, body mass index (BMI), lung function and postoperative complications.
Among 141 patients, 73 presented with sarcopenia (sarcopenia group) and 68 did not (non-sarcopenia group). The mean skeletal muscle index in all patients was 49.5±9.0 cm/m; median, 49.3 cm/m. The sarcopenia group included a higher proportion of men (P=0.039) and had a lower BMI than the non-sarcopenia group (P=0.001). There were no significant differences in any other clinical and pathological features. The incidences of postoperative complications in the sarcopenia and non-sarcopenia groups were 63.0% and 36.8%, respectively (P=0.002). The incidences of pulmonary infections and postoperative pleural effusions were 28.8% 11.8% (P=0.011) and 38.4% 20.6% (P=0.020) in the sarcopenia and non-sarcopenia groups, respectively. The incidences of other complications were not significantly different between the two groups. Univariate and multivariate analyses of pulmonary infection-related clinical factors revealed that sarcopenia and forced expiratory volume in the first second as a percent of forced vital capacity (FEV1.0%) were independent risk factors for pulmonary infection after minimally invasive surgery.
Preoperative sarcopenia is an independent risk factor for pulmonary infection after minimally invasive oesophagectomy (MIE). Evaluation of preoperative sarcopenia will thus help to prevent postoperative complications.
肌肉减少症与某些癌症患者的手术并发症密切相关。在本研究中，我们评估了食管鳞状细胞癌患者肌肉减少症与术后并发症之间的关系。
我们回顾性分析了接受胸腔镜联合腹腔镜食管癌根治术的患者。术前行计算机断层扫描以评估骨骼肌质量，诊断肌肉减少症，并评估其与年龄、体重指数（BMI）、肺功能和术后并发症的相关性。
141例患者中，73例存在肌肉减少症（肌肉减少症组），68例不存在（非肌肉减少症组）。所有患者的平均骨骼肌指数为49.5±9.0 cm/m；中位数为49.3 cm/m。肌肉减少症组男性比例较高（P=0.039），且BMI低于非肌肉减少症组（P=0.001）。其他临床和病理特征无显著差异。肌肉减少症组和非肌肉减少症组术后并发症的发生率分别为63.0%和36.8%（P=0.002）。肌肉减少症组和非肌肉减少症组肺部感染和术后胸腔积液的发生率分别为28.8%对11.8%（P=0.011）和38.4%对20.6%（P=0.020）。两组其他并发症的发生率无显著差异。对肺部感染相关临床因素进行单因素和多因素分析显示，肌肉减少症和第1秒用力呼气量占用力肺活量的百分比（FEV1.0%）是微创手术后肺部感染的独立危险因素。
术前肌肉减少症是微创食管切除术后肺部感染的独立危险因素。因此，术前评估肌肉减少症将有助于预防术后并发症。
