The impact of skeletal muscle wasting during neoadjuvant chemotherapy on postoperative anastomotic leakage in patients w
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ORIGINAL ARTICLE
The impact of skeletal muscle wasting during neoadjuvant chemotherapy on postoperative anastomotic leakage in patients with esophageal cancer Shiro Fujihata1 · Ryo Ogawa1 · Seiichi Nakaya1 · Shunsuke Hayakawa1 · Tomotaka Okubo1 · Hiroyuki Sagawa1 · Tatsuya Tanaka1 · Hiroki Takahashi1 · Yoichi Matsuo1 · Shuji Takiguchi1 Received: 8 March 2020 / Accepted: 24 August 2020 © The Japan Esophageal Society 2020
Abstract Background Sarcopenia is defined by low muscle mass and low muscle strength and is a prognostic factor of unfavorable outcomes in various diseases. The purpose of this study is to examine the correlation between skeletal muscle wasting (SMW) during neoadjuvant chemotherapy (NAC) and postoperative complications in patients with esophageal cancer, particularly in relation to anastomotic leakage. Methods The present study involved 99 patients with thoracic esophageal cancer and esophago-gastric junctional cancer who received NAC followed by radical esophagectomy between August 2008 to June 2019, and who were pStage 0–III. Patient demographics and clinical variables were retrospectively reviewed. For assessing the extent of SMW, the rate of change in skeletal muscle mass index (SMI) was measured from CT images at the level of the third lumbar vertebra. Factors associated with postoperative complications were also examined. Results The median rate of change in total SMI in patients was − 1.87%. The decreased rates in SMI of the side abdominal muscles and rectus abdominis were significantly greater than that of the psoas major (side abdominal muscles: p = 0.0084, rectus abdominis: p = 0.036). Multivariate analysis showed a decreased rate in SMI, especially in the erector spinae muscle, and the Charlson comorbidity index (CCI) was significantly associated with Grade IIIa of higher anastomotic leakage (Grade ≥ IIIa) (SMI cutoff (favorable): ≤ − 7.84, p = 0.0040; CCI cutoff (favorable): ≥ 2, p = 0.0032). Conclusion In patients with esophageal cancer, SMI tend to decrease during NAC treatment. It is therefore important to prevent the additional impact that SMW during NAC has on postoperative anastomotic leakage. Keywords Sarcopenia · Skeletal muscle wasting · Esophageal cancer · Esophagectomy · Anastomotic leakage
Background Anorexia and cachexia, as well as tumor obstruction, can lead to malnutrition in patients with esophageal cancer preoperatively. For evaluating patients’ nutritional status, various parameters have customarily been used, such as serum Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10388-020-00774-1) contains supplementary material, which is available to authorized users. * Shiro Fujihata shiro‑‑[email protected] 1
Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho‑cho, 1 Kawasumi, Mizuho‑ku, Nagoya, Aichi, Japan
albumin levels and body mass index (BMI) [1, 2]. More recently, sarcopenia has been proposed as a new index that reflects malnutrition, and
