LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
Department of Biostatistics, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
J Gastrointest Surg. 2021 Dec;25(12):3040-3048. doi: 10.1007/s11605-021-05183-y. Epub 2021 Nov 2.
Sarcopenia, loss of muscle mass and strength, has been associated with more frequent complications after esophagectomy. This study compared hand-grip strength, muscle mass, and intramuscular adipose tissue as predictors of postoperative outcomes and mortality after esophagectomy.
Minimally invasive esophagectomy was performed on 175 patients with esophageal cancer. Skeletal muscle index and skeletal muscle density were derived from preoperative CTs. Hand-grip strength was measured using dynamometer. Univariate and multivariable analyses were performed.
Preoperative hand-grip strength was normal in 91 (52%), intermediate in 43 (25%), and weak in 41 (23%) patients. Hand-grip strength was significantly correlated with both skeletal muscle index and skeletal muscle density. Postoperative pneumonia occurred in 8/41 (20%) patients with weak strength compared to 4/91 (4%) with normal strength (p = 0.006; Cochran-Armitage Test). Prolonged postoperative ventilation occurred in 11/41 (27%) patients with weak strength compared to 11/91 (12%) with normal strength (p = 0.036). Median length of stay was 9 days in patients with weak strength compared to 7 days for those with normal strength (p = 0.005; Kruskal-Wallis Test). Discharge to non-home location occurred in 15/41 (37%) with weak strength compared to 8/91 (9%) with normal strength (p < 0.001). Postoperative mortality at 90 days was 4/41 (10%) with weak strength compared with no mortalities (0/91) in the normal strength group (p = 0.004). Mortality at 1 year was 18/39 (46%) in patients with weak strength compared to 6/81 (7%) with normal strength, among 158 patients with 1-year follow-up (p < 0.001).
Preoperative hand-grip strength was found to be a powerful predictor of postoperative pneumonia, length of stay, discharge to non-home location, and mortality after esophagectomy.
肌肉减少症，即肌肉质量和力量的丧失，与食管癌手术后更频繁发生并发症有关。本研究比较了握力、肌肉质量和肌肉内脂肪组织作为食管癌手术后结局和死亡率的预测指标。
对 175 例食管癌患者行微创食管切除术。从术前 CT 中得出骨骼肌指数和骨骼肌密度。使用测力计测量握力。进行单变量和多变量分析。
术前握力正常的患者 91 例（52%），中等的患者 43 例（25%），弱的患者 41 例（23%）。握力与骨骼肌指数和骨骼肌密度均显著相关。术后肺炎发生在 41 例握力弱的患者中 8 例（20%），而在 91 例握力正常的患者中仅 4 例（4%）（p = 0.006；Cochran-Armitage 检验）。握力弱的患者中，术后通气时间延长 11 例（27%），而握力正常的患者中 11 例（12%）（p = 0.036）。握力弱的患者中位住院时间为 9 天，而握力正常的患者为 7 天（p = 0.005；Kruskal-Wallis 检验）。握力弱的患者中有 15 例（37%）出院至非家庭地点，而握力正常的患者中仅 8 例（9%）（p < 0.001）。握力弱的患者术后 90 天死亡率为 4 例（10%），而握力正常的患者中无一例死亡（0/91）（p = 0.004）。在 158 例有 1 年随访的患者中，握力弱的患者 1 年死亡率为 18/39（46%），而握力正常的患者为 6/81（7%）（p < 0.001）。
术前握力是食管癌手术后肺炎、住院时间、出院至非家庭地点和死亡率的有力预测指标。
