Brown Leo R, Ramage Michael I, Dolan Ross D, Sayers Judith, Bruce Nikki, Dick Lachlan, Sami Sharukh, McMillan Donald C, Laird Barry J A, Wigmore Stephen J, Skipworth Richard J E
Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
Cancers (Basel). 2023 Apr 30;15(9):2577. doi: 10.3390/cancers15092577.
This study aimed to longitudinally assess CT body composition analyses in patients who experienced anastomotic leak post-oesophagectomy. Consecutive patients, between 1 January 2012 and 1 January 2022 were identified from a prospectively maintained database. Changes in computed tomography (CT) body composition at the third lumbar vertebral level (remote from the site of complication) were assessed across four time points where available: staging, pre-operative/post-neoadjuvant treatment, post-leak, and late follow-up. A total of 20 patients (median 65 years, 90% male) were included, with a total of 66 computed tomography (CT) scans analysed. Of these, 16 underwent neoadjuvant chemo(radio)therapy prior to oesophagectomy. Skeletal muscle index (SMI) was significantly reduced following neoadjuvant treatment ( < 0.001). Following the inflammatory response associated with surgery and anastomotic leak, a decrease in SMI (mean difference: -4.23 cm/m, < 0.001) was noted. Estimates of intramuscular and subcutaneous adipose tissue quantity conversely increased (both < 0.001). Skeletal muscle density fell (mean difference: -5.42 HU, = 0.049) while visceral and subcutaneous fat density were higher following anastomotic leak. Thus, all tissues trended towards the radiodensity of water. Although tissue radiodensity and subcutaneous fat area normalised on late follow-up scans, skeletal muscle index remained below pre-treatment levels.
本研究旨在纵向评估食管癌切除术后发生吻合口漏患者的CT身体成分分析。从一个前瞻性维护的数据库中识别出2012年1月1日至2022年1月1日期间的连续患者。在可获得的四个时间点评估第三腰椎水平（远离并发症部位）的计算机断层扫描（CT）身体成分变化：分期、术前/新辅助治疗后、漏后和晚期随访。共纳入20例患者（中位年龄65岁，90%为男性），共分析了66次计算机断层扫描（CT）。其中，16例在食管癌切除术前接受了新辅助化疗（放疗）。新辅助治疗后骨骼肌指数（SMI）显著降低（<0.001）。在与手术和吻合口漏相关的炎症反应后，观察到SMI下降（平均差异：-4.23 cm/m，<0.001）。相反，肌内和皮下脂肪组织量估计增加（均<0.001）。吻合口漏后骨骼肌密度下降（平均差异：-5.42 HU，=0.049），而内脏和皮下脂肪密度较高。因此，所有组织的密度都趋向于水的密度。尽管在晚期随访扫描中组织密度和皮下脂肪面积恢复正常，但骨骼肌指数仍低于治疗前水平。
