Abstract
Background
Exact measurement of muscle mass is enabled by body composition analyzer, and it is reported that a body composition affects the perioperative outcomes. In this study, we investigated the relationship between depletion of preoperative muscle mass (sarcopenia) and postoperative outcomes in patients with esophageal cancer treated esophagectomy.
Methods
A total 58 esophageal cancer patients who underwent esophagectomy between January 2014 and January 2018 were enrolled. Preoperative muscle mass was evaluated by InBody-3.0 and S-10 which is body composition analyzer and expressed as muscle mass index; MMI (kg/m2) by dividing the muscle mass by the height in meters squared. The cut off values of MMI were the gender-specific lowest 20%, and we defined low MMI as sarcopenia. Postoperative complications were graded according to the Clavien-Dindo classification, univariate and multivariate analysis were performed for postoperative pneumonia. About the pneumonia, we defined that invasive shadow was observed by X-ray or CT and bacteria detected by sputum culture.
Results
By the definition of sarcopenia in this study, sarcopenia was determined in 11 patients (19%). Sarcopenia was significantly correlated with lower body weight (P < 0.001), lower body mass index (P < 0.001), the VC% (P = 0.0178). In other factors, there is no significant difference between sarcopenia and non-sarcopenia groups. Compared with non-sarcopenic patients, sarcopenic patients had a higher risk of postoperative pneumonia and chylothorax (P = 0.0144 and P = 0.0105). For other complications, the differences were not significant. In univariate analysis, sarcopenia (P = 0.0144), hypoalbuminemia (P = 0.0236), operative blood loss (P = 0.0436) were associated with postoperative pneumonia. Multivariate analysis revealed that sarcopenia (P < 0.001) and longer operation time (P = 0.0354) were independent predictors of postoperative pneumonia.
Conclusion
Preoperative sarcopenia was identified as independent risk factor for postoperative pneumonia after esophagectomy. Preoperative nutrition and rehabilitation therapy may contribute to the prevention of pneumonia after surgery.
Disclosure
All authors have declared no conflicts of interest.