Herzberg Jonas, Strate Tim, Passlack Leon, Guraya Salman Yousuf, Honarpisheh Human
Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, 21465 Reinbek, Germany.
Department of Internal Medicine, Krankenhaus Reinbek St. Adolf-Stift, 21465 Reinbek, Germany.
Cancers (Basel). 2024 Dec 18;16(24):4217. doi: 10.3390/cancers16244217.
Surgery for esophageal cancer has an associated high rate of postoperative complications such as anastomotic leakage (AL) and fistulas. Pre-operative sarcopenia as a loss of skeletal muscle mass and function is identified as a potential prognostic factor in determining the outcomes of oncological surgical resections for esophageal cancers. In this study, we evaluated the impact of body composition on postoperative complications in esophageal cancer surgery.
In this cohort study, we analyzed patients' body composition at the level of the third lumbar vertebra on CT scans before Ivor Lewis resections for esophageal cancers between January 2015 and December 2022. Patients with a skeletal muscle index (SMI) ≤ 38.5 cm/m in women and ≤52.4 cm/m in men were classified as sarcopenic. Postoperative complications were categorized following the Dindo-Clavien classification and included AL, postoperative pneumonia, length of hospital stay, and failure-to-rescue which were compared between the sarcopenic and non-sarcopenic patients.
From a group of 111 patients with Ivor Lewis esophagectomy, 70 patients (63.1%) were classified as sarcopenic based on the SMI and the previously published gender-specific cut-off values. AL occurred at 12.6% (5.6% in adenocarcinoma). Within the whole cohort, patients with AL had a significantly low SMI of 43.487 ± 8.088 vs. 48.668 ± 7.514; = 0.012. Additionally, the SMI showed a negative correlation to the length of postoperative hospital stay (r = -0.204; = 0.032; = 111). The failure-to-rescue rate was higher in the group of sarcopenic patients (12.8% vs. 8%).
Our data showed a correlation between SMI and AL. This effect could not be seen in gender-specific SMI. This study showed a lower failure-to-rescue rate in non-sarcopenic patients after Ivor Lewis esophagectomy. These findings underscore the crucial role of determining the preoperative nutritional and body composition status as measured by the preoperative CT scans.
食管癌手术术后并发症发生率较高，如吻合口漏（AL）和瘘。术前肌肉减少症作为骨骼肌质量和功能的丧失，被认为是决定食管癌肿瘤外科切除术后预后的一个潜在因素。在本研究中，我们评估了身体组成对食管癌手术术后并发症的影响。
在这项队列研究中，我们分析了2015年1月至2022年12月期间接受艾弗·刘易斯食管癌切除术之前，患者在CT扫描中第三腰椎水平的身体组成情况。骨骼肌指数（SMI）女性≤38.5 cm/m、男性≤52.4 cm/m的患者被归类为肌肉减少症患者。术后并发症按照迪诺-克莱维恩分类法进行分类，包括吻合口漏、术后肺炎、住院时间和未抢救成功情况，并在肌肉减少症患者和非肌肉减少症患者之间进行比较。
在一组111例行艾弗·刘易斯食管切除术的患者中，根据SMI和先前公布的性别特异性临界值，70例患者（63.1%）被归类为肌肉减少症患者。吻合口漏发生率为12.6%（腺癌为5.6%）。在整个队列中，发生吻合口漏的患者SMI显著较低，分别为43.487±8.088和48.668±7.514；P = 0.012。此外，SMI与术后住院时间呈负相关（r = -0.204；P = 0.032；n = 111）。肌肉减少症患者组的未抢救成功率更高（12.8%对8%）。
我们的数据显示SMI与吻合口漏之间存在相关性。在性别特异性SMI中未观察到这种效应。本研究显示，艾弗·刘易斯食管切除术后非肌肉减少症患者的未抢救成功率较低。这些发现强调了通过术前CT扫描确定术前营养和身体组成状况的关键作用。
