Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery (RPA IAS), Sydney, Australia; School of Medicine, University of Notre Dame, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.
Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Department of Radiology, Royal North Shore Hospital, Sydney, Australia.
J Gastrointest Surg. 2024 Jun;28(6):805-812. doi: 10.1016/j.gassur.2024.03.001. Epub 2024 Mar 4.
The impact of sarcopenia on outcomes after esophagectomy is controversial. Most data are currently derived from Asian populations. This study aimed to correlate sarcopenia to short-term perioperative complication rates and long-term survival and recurrence outcomes.
A retrospective analysis was performed of patients undergoing esophagectomy for cancer from 3 tertiary referral centers in Australia. Sarcopenia was defined using cutoffs for skeletal muscle index (SMI), assessed on preoperative computed tomography images. Outcomes measured included complications, overall survival (OS), and disease-free survival (DFS).
Of 462 patients (78.4% male; median age, 67 years), sarcopenia was evident in 276 (59.7%). Patients with sarcopenia had a higher rate of major (Clavien-Dindo ≥ 3b) complications (27.9% vs 14.5%; P < .001), including higher rates of postoperative cardiac arrythmia (16.3% vs 9.7%; P = .042), pneumonia requiring antibiotics (14.5% vs 9.1%; P = .008), and 30-day mortality (5.1% vs 0%; P = .002). In the sarcopenic group, the median OS was lower (37 months [95% CI, 27.1-46.9] vs 114 months [95% CI, 75.8-152.2]; P < .001), as was the median DFS (27 months [95% CI, 18.9-35.1] vs 77 months [95% CI, 36.4-117.6]; P < .001). Sarcopenia was an independent risk factor for lower survival on multivariate analysis (hazard ratio, 1.688; 95% CI, 1.223-2.329; P = .001).
Patients with preoperative sarcopenia based on analysis of SMI are at a higher risk of major complications and have inferior survival and oncologic outcomes after esophagectomy for esophageal cancer.
肌少症对食管癌术后结局的影响存在争议。目前大多数数据来自亚洲人群。本研究旨在探讨肌少症与短期围手术期并发症发生率及长期生存和复发结局的相关性。
对澳大利亚 3 个三级转诊中心行食管癌切除术的癌症患者进行回顾性分析。采用术前 CT 图像评估骨骼肌指数（SMI）的截断值来定义肌少症。测量的结局包括并发症、总生存期（OS）和无病生存期（DFS）。
462 例患者（78.4%为男性；中位年龄 67 岁）中，276 例（59.7%）存在肌少症。肌少症患者的主要（Clavien-Dindo ≥ 3b）并发症发生率更高（27.9%比 14.5%；P<0.001），包括术后心律失常（16.3%比 9.7%；P=0.042）、肺炎需用抗生素（14.5%比 9.1%；P=0.008）和 30 天死亡率（5.1%比 0%；P=0.002）更高。在肌少症组中，中位 OS 更低（37 个月[95%CI，27.1-46.9]比 114 个月[95%CI，75.8-152.2]；P<0.001），中位 DFS 也更低（27 个月[95%CI，18.9-35.1]比 77 个月[95%CI，36.4-117.6]；P<0.001）。多因素分析显示，肌少症是生存时间较短的独立危险因素（危险比，1.688；95%CI，1.223-2.329；P=0.001）。
基于 SMI 分析的术前肌少症患者在接受食管癌切除术治疗食管癌后发生重大并发症的风险更高，且生存和肿瘤学结局更差。
