Identification of Preoperative Fat-Free Mass Index for the Prognosis of Curatively Resected Esophageal Cancer

SUMMARY Although neoadjuvant chemoradiotherapy (nCRT) is frequently used in esophageal cancer patients undergoing treatment with curative intent, it can negatively impact patients’ physical fitness. A decline in physical fitness during chemoradiotherapy may be an indication of vulnerability. The aim of this study was to evaluate whether changes in physical fitness, weight, and fat-free mass index (FFMI) during nCRT can predict the risk of postoperative pneumonia. A retrospective longitudinal observational cohort study was performed in patients who received curative treatment for esophageal cancer between September 2016 and September 2018 in a high-volume center for esophageal cancer surgery. Physical fitness (handgrip strength, leg extension strength, and exercise capacity), weight, and FFMI were measured before and after chemoradiotherapy. To be included in the data analyses, pre- and post-nCRT data had to be available of at least one of the outcome measures. Logistic regression analyses were performed to evaluate the predictive value of changes in physical fitness, weight, and FFMI during nCRT on postoperative pneumonia, as defined by the Uniform Pneumonia Scale. In total, 91 patients were included in the data analyses. Significant associations were found between the changes in handgrip strength (odds ratio [OR] 0.880, 95% confidence interval [CI]: 0.813–0.952) and exercise capacity (OR 0.939, 95%CI: 0.887–0.993) and the occurrence of postoperative pneumonia. All pneumonias occurred in patients with declines in handgrip strength and exercise capacity after nCRT. A decrease of handgrip strength and exercise capacity during nCRT predicts the risk of pneumonia after esophagectomy for cancer. Measuring physical fitness before and after chemoradiotherapy seems an adequate method to identify patients at risk of postoperative pneumonia.

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Impact of sarcopenia (Sp) on outcomes in patients (pts) undergoing trimodality therapy for esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.221 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 221-221

Author(s):

Brian Weston ◽

Talha Shaikh ◽

Elizabeth Handorf ◽

Walter Joseph Scott ◽

Steven J. Cohen ◽

...

Keyword(s):

Esophageal Cancer ◽

Subcutaneous Fat ◽

Disease Free Survival ◽

Neoadjuvant Chemoradiation ◽

Fat Free Mass ◽

Cancer Center ◽

Muscle Area ◽

Trimodality Therapy ◽

Operative Outcomes ◽

Skeletal Muscle Area

221 Background: Sp, or severe muscle wasting, has been implicated as an important prognostic factor in cancer pts. We assessed the association between body composition changes and outcomes in pts with esophageal cancer undergoing tri-modality therapy. Methods: Following IRB approval, we reviewed all pts who underwent chemoradiation followed by esophagectomy at an NCI-designated cancer center from 2000-2013. Pts who underwent CT assessment pre- and post-neoadjuvant chemoradiation were included in the analysis. Sp was defined as a lumbar skeletal muscle area/height of 55.4 cm2/m2 for males and 38.9 cm2/m2for females. Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (SFMR), and visceral to subcutaneous adipose tissue ratio (VSATR) were also derived using CT-based measures. Changes in the above parameters and Sp were correlated to post-operative (post-op) complications (cx), treatment (tx) response, disease free survival (DFS), and overall survival (OS). Analysis was performed using non-parametric Wilcoxon and Kruskal-Wallis tests, and Kaplan-Meier curves with log-rank tests. Results: A total of 48 pts met the inclusion criteria; the median age was 62 (range 42-80) with a median follow up of 28 months (range 4-103). Most pts had T3 (85%), N1 (70%), or M0/M1a disease (92%). Ten pts (21%) had Sp at the initiation of tx, with 9 of these remaining Sp post-tx, and 1 patient developing Sp. Post-tx Sp was associated with an increased rate of post-op mortality (p=0.03). Three of the 10 patients with Sp died post-op versus 1/36 in the non-Sp group. Post-tx Sp was associated with a decreased rate of post-op strictures (p = 0.04). Thirteen of the 36 pts in the non-Sp group developed strictures versus none in the Sp group. There was a significant change in all other measures pre vs. post-tx; FM (-4.3 kg/m2, p<0.01), FFM (-5.0 kg/m2, p<0.01), SFMR (-0.1, p=0.04), and VSATR (-0.02, p<0.01). None of these were correlated with post-op cx, tx response, DFS, or OS. Conclusions: Post-tx Sp was associated with an increased incidence of post-op mortality but a lower rate of strictures. Our study was limited by sample size, and further studies should examine the relationship between Sp and peri-operative outcomes.

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Considerations in Dysphagia Management Following Esophagectomy

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig13.169 ◽

2016 ◽

Vol 1 (13) ◽

pp. 169-176

Author(s):

Lisa M. Evangelista ◽

James L. Coyle

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Surgical Procedures ◽

Esophageal Resection ◽

Minimally Invasive Surgical ◽

Operative Complications ◽

Swallowing Difficulties ◽

Epidemiological Impact ◽

Invasive Techniques ◽

Management Of Dysphagia

Esophageal cancer is the sixth leading cause of death from cancer worldwide. Esophageal resection is the mainstay treatment for cancers of the esophagus. While curative, surgical resection may result in swallowing difficulties that require intervention from speech-language pathologists (SLPs). Minimally invasive surgical procedures for esophageal resection have aimed to reduce morbidity and mortality associated with more invasive techniques. Both intra-operative and post-operative complications, regardless of the surgical approach, can result in dysphagia. This article will review the epidemiological impact of esophageal cancers, operative complications resulting in dysphagia, and clinical assessment and management of dysphagia pertinent to esophageal resection.

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