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Impact of Preoperative Skeletal Muscle Mass and Nutritional Status on Short-and Long-Term Outcomes After Esophagectomy for Esophageal Cancer: A Retrospective Observational Study

Impact of Psoas Muscle Mass and Body Mass on Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Preoperative muscle volume and body mass index (BMI) are associated with postoperative outcomes. Because esophagectomy for esophageal cancer (EC) is associated with high morbidity and because EC has a poor prognosis, this study investigated the association of preoperative skeletal muscle mass and nutritional status with postoperative outcomes.

Methods

The study analyzed 483 patients who underwent esophagectomy from 2009 to 2012. The cross-sectional area of the psoas muscle index (PMI) was measured at the third lumbar vertebral level using computed tomography. Clavien–Dindo classifications were used to analyze postoperative complications. Because skeletal muscle mass varies according to sex, all analyses were performed accordingly (390 males, 93 females).

Results

For male patients, BMI was a significant multivariate factor, and PMI, a univariate factor, predicted postoperative complications and overall survival (OS). Using a preoperative nutritional and muscular (PNM) score derived from BMI and PMI results (patients were allocated 1 point if their BMI was < 18.5 kg/m2 and 1 point if their PMI was < 600 mm2/m2, for a possible maximum total of 2 points), male patients were categorized as high risk (score 2), moderate risk (score 1), or low risk (score 0). In the low-risk group, anastomotic leakage was significantly less (p = 0.01), and the 3-year OS was significantly better (p < 0.01). On the other hand, in female patients, neither BMI nor PMI was a significant factor for postoperative outcomes.

Conclusions

For male patients, the PNM score is a promising tool for predicting postoperative outcomes and identifying patients requiring preoperative nutritional intervention and rehabilitation.

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References

  1. Global Burden of Disease Cancer Collaboration. The global burden of cancer 2013. JAMA Oncol. 2015;1:505–27.

    Article  PubMed Central  Google Scholar 

  2. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics 2012. CA Cancer J Clin. 2015;65:87–108.

    Article  PubMed  Google Scholar 

  3. Takeuchi H, Miyata H, Ozawa S, et al. Comparison of short-term outcomes between open and minimally invasive esophagectomy for esophageal cancer using a nationwide database in Japan. Ann Surg Oncol. 2017;24:1821–7.

    Article  PubMed  Google Scholar 

  4. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9:629–35.

    Article  PubMed  Google Scholar 

  5. Nishigori T, Okabe H, Tanaka E, et al. Sarcopenia as a predictor of pulmonary complications after esophagectomy for thoracic esophageal cancer. J Surg Oncol. 2016;113:678–84.

    Article  PubMed  Google Scholar 

  6. Nakamura N, Hara T, Shibata Y, et al. Sarcopenia is an independent prognostic factor in male patients with diffuse large B-cell lymphoma. Ann Hematol. 2015;94:2043–53.

    Article  PubMed  Google Scholar 

  7. Shen W, Punyanitya M, Wang Z, et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol. 2004;97:2333–8.

    Article  PubMed  Google Scholar 

  8. Moutzakis M, Prado CM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33:997–1006.

    Article  Google Scholar 

  9. Voron T, Tselikas L, Pietrasz D, et al. Sarcopenia impacts on short- and long-term results of hepatectomy for hepatocellular carcinoma. Ann Surg. 2015;261:1173–83.

    Article  PubMed  Google Scholar 

  10. Ida S, Watanabe M, Yoshida N, et al. Sarcopenia is a predictor of postoperative respiratory complications in patients with esophageal cancer. Ann Surg Oncol. 2015;22:4432–7.

    Article  PubMed  Google Scholar 

  11. Levolger S, van Vugt JL, de Bruin RW, et al. Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies. Br J Surg. 2015;102:1448–58.

    Article  CAS  PubMed  Google Scholar 

  12. Shachar SS, Williams GR, Muss HB, et al. Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer. 2016;57:58–67.

    Article  PubMed  Google Scholar 

  13. Nakashima Y, Saeki H, Nakanihi R, et al. Assessment of sarcopenia as a predictor of poor outcomes after esophagectomy in elderly patients with esophageal cancer. Ann Surg. 2017;25:456. https://doi.org/10.1097/sla.0000000000002252.

    Article  Google Scholar 

  14. Tamandl D, Paireder M, Asari R, et al. Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer. Eur Radiol. 2016;26:1359–67.

    Article  PubMed  Google Scholar 

  15. Harimoto N, Yoshizumi T, Shimokawa M, et al. Sarcopenia is a poor prognostic factor following hepatic resection in patients aged 70 years and older with hepatocellular carcinoma. Hepatol Res. 2016;46:1247–55.

    Article  PubMed  Google Scholar 

  16. Zheng ZF, Lu J, Zheng CH, et al. A novel prognostic scoring system based on preoperative sarcopenia predicts the long-term outcome for patients after R0 resection for gastric cancer: experiences of a high-volume center. Ann Surg Oncol. 2017;24:1795–803.

    Article  PubMed  Google Scholar 

  17. Paireder M, Asari R, Kristo I, et al. Impact of sarcopenia on outcome in patients with esophageal resection following neoadjuvant chemotherapy for esophageal cancer. Eur J Surg Oncol. 2017;43:478–84.

    Article  CAS  PubMed  Google Scholar 

  18. Harada K, Ida S, Baba Y, et al. Prognostic and clinical impact of sarcopenia in esophageal squamous cell carcinoma. Dis Esophagus. 2016;29:627–33.

    Article  CAS  PubMed  Google Scholar 

  19. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Aging. 2010;39:412–23.

    Article  Google Scholar 

  20. Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15:95–101.

    Article  PubMed  Google Scholar 

  21. Morita M, Otsu H, Kawano H, et al. Gender differences in prognosis after esophagectomy for esophageal cancer. Surg Today. 2014;44:505–12.

    Article  PubMed  Google Scholar 

  22. Shimada H, Matsubara H, Okazumi S, et al. Improved surgical results in thoracic esophageal squamous cell carcinoma: a 40-year analysis of 792 patients. J Gastrointest Surg. 2008;12:518–26.

    Article  PubMed  Google Scholar 

  23. Law S, Kwong DL, Kwok KF, et al. Improvement in treatment results and long-term survival of patients with esophageal cancer: impact of chemoradiation and change in treatment strategy. Ann Surg. 2003;238:339–47.

    PubMed  PubMed Central  Google Scholar 

  24. Cancer Therapy Evaluation Program. Common toxicity criteria. Version 2.0 (1999). Retrieved 9 Feb 2018. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcv20_430-992.pdf.

  25. Onodera T, Goseki N, Kosaki G, et al. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85:1001–5.

    CAS  PubMed  Google Scholar 

  26. Miki C, Kusunoki M. Perioperative nutritional management in various clinical condition: diseases of lower digestive system. Nihon Geka Gakkai Zasshi. 2010;111:368–72.

    PubMed  Google Scholar 

  27. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Breiman L, Friedman JH, Olshen RA, et al. Classification and regression trees (Wadsworth statistics/probability). Chapman & Hall, Boca Raton, 1984.

    Google Scholar 

  29. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transpl. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  30. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. World Health Organization, Geneva, 1995.

  31. Sheetz KH, Zhao L, Holcombe SA, et al. Decreased core muscle size is associated with worse patient survival following esophagectomy for cancer. Dis Esophagus. 2013;26:716–22.

    CAS  PubMed  Google Scholar 

  32. Hamaguchi Y, Kaido T, Okumura S, et al. Proposal for new diagnostic criteria of low skeletal muscle mass based on computed tomography imaging in Asian adults. Nutrition. 2016;32:1200–5.

    Article  PubMed  Google Scholar 

  33. Tanimoto Y, Watanabe M, Kono R, et al. Aging changes in muscle mass of Japanese. Nippon Ronen Igakkai Zasshi. 2010:47;52–7.

    Article  PubMed  Google Scholar 

  34. Shimohata H, Ando F. Association of daily physical performance with muscle volume and strength. Nippon Ronen Igakkai Zasshi. 2012:49;195–8.

    Article  Google Scholar 

  35. Sanada K, Miyachi M, Tanimoto M, et al. A cross-sectional study of sarcopenia in Japanese men and women: reference values and association with cardiovascular risk factors. Eur J Appl Physiol. 2010:110;57–65.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Toshiaki Shichinohe MD, PhD.

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Shichinohe, T., Uemura, S., Hirano, S. et al. Impact of Preoperative Skeletal Muscle Mass and Nutritional Status on Short-and Long-Term Outcomes After Esophagectomy for Esophageal Cancer: A Retrospective Observational Study. Ann Surg Oncol 26, 1301–1310 (2019). https://doi.org/10.1245/s10434-019-07188-z

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  • DOI: https://doi.org/10.1245/s10434-019-07188-z

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