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Skeletal Muscle Loss After Esophagectomy Is an Independent Risk Factor for Patients with Esophageal Cancer

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

Abstract

Background

Postoperative changes in skeletal muscle and their influence on outcomes after esophagectomy for patients with esophageal cancer have not been fully investigated. This study aimed to confirm that postoperative skeletal muscle decrease influences long-term patient outcomes.

Methods

Data were collected from 218 patients who underwent curative esophagectomy for esophageal cancer whose data were available before and 6 months after surgery. The skeletal muscle index (SMI) was measured at the level of the L3 vertebrae, and the postoperative change in the SMI compared with preoperative values was calculated as the delta SMI.

Results

The mean SMI value was − 11.64%, and the median delta SMI value was − 11.88%. The first and third quartiles were defined as cutoffs, and 218 patients were classified as the mild-loss group (54 patients), moderate-loss group (110 patients), and severe-loss group (54 patients). The patients with a more severely reduced SMI had a worse prognosis (5-year overall survival rates: mild loss, 66.6%; moderate loss, 58.8%; and severe loss, 48.5%; p = 0.0314). This correlation between reduced SMI and prognosis also was observed for the patients with preoperative sarcopenia (p < 0.0001), but not for those without preoperative sarcopenia.

Conclusions

Postoperative reduced SMI and worse prognosis were significantly associated in esophageal cancer patients.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.

    Article  CAS  Google Scholar 

  2. Nakashima Y, Saeki H, Yukaya T, et al. Blood flow assessment with indocyanine green fluorescence angiography for pedicled omental flap on cervical esophagogastric anastomosis after esophagectomy. J Am Coll Surg. 2016;222:e67–9.

    Article  Google Scholar 

  3. Saeki H, Nakashima Y, Hirose K, et al. “Energy-less technique” with mini-clips for recurrent laryngeal nerve lymph node dissection in prone thoracoscopic esophagectomy for esophageal cancer. Am J Surg. 2018;216:1212–4.

    Article  Google Scholar 

  4. Nakashima Y, Saeki H, Hu Q, et al. Neoadjuvant chemotherapy versus chemoradiotherapy for patients with esophageal squamous cell carcinoma. Anticancer Res. 2018;38:6809–14.

    Article  Google Scholar 

  5. Martin L, Lagergren P. Long-term weight change after oesophageal cancer surgery. Br J Surg. 2009;96:1308–14.

    Article  CAS  Google Scholar 

  6. Baker M, Halliday V, Williams RN, Bowrey DJ. A systematic review of the nutritional consequences of esophagectomy. Clin Nutr. 2016;35:987–94.

    Article  Google Scholar 

  7. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127(5 Suppl):990S–91S.

    Article  CAS  Google Scholar 

  8. 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  Google Scholar 

  9. Itoh S, Shirabe K, Matsumoto Y, et al. Effect of body composition on outcomes after hepatic resection for hepatocellular carcinoma. Ann Surg Oncol. 2014;21:3063–8.

    Article  Google Scholar 

  10. Nakashima Y, Saeki H, Nakanishi R, et al. Assessment of sarcopenia as a predictor of poor outcomes after esophagectomy in elderly patients with esophageal cancer. Ann Surg. 2018;267:1100–4.

    Article  Google Scholar 

  11. 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  Google Scholar 

  12. Japan Esophageal Society. Japanese classification of esophageal cancer, tenth edition: part I. Esophagus. 2009;6:1–25.

    Article  Google Scholar 

  13. Japan Esophageal Society. Japanese classification of esophageal cancer, tenth edition: parts II and III. Esophagus. 2009;6:71–94.

    Article  Google Scholar 

  14. Miyazaki T, Sakai M, Sohda M, et al. Prognostic significance of inflammatory and nutritional parameters in patients with esophageal cancer. Anticancer Res. 2016;36:6557–62.

    Article  CAS  Google Scholar 

  15. Ignacio de Ulíbarri J, González-Madroño A, de Villar NGP, et al. CONUT: a tool for controlling nutritional status: first validation in a hospital population. Nutr Hosp. 20:38–45.

  16. D’Journo XB, Ouattara M, Loundou A, et al. Prognostic impact of weight loss in 1-year survivors after transthoracic esophagectomy for cancer. Dis Esophagus. 2012;25:527–34.

    Article  Google Scholar 

  17. Park SY, Yoon J-K, Lee SJ, Haam S, Jung J. Postoperative change of the psoas muscle area as a predictor of survival in surgically treated esophageal cancer patients. J Thorac Dis. 2017;9:355–61.

    Article  Google Scholar 

  18. Mayanagi S, Tsubosa Y, Omae K, et al. Negative impact of skeletal muscle wasting after neoadjuvant chemotherapy followed by surgery on survival for patients with thoracic esophageal cancer. Ann Surg Oncol. 2017;24:3741–7.

    Article  Google Scholar 

  19. Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104:815–40.

    Article  Google Scholar 

  20. Aoi W, Naito Y, Takagi T, et al. A novel myokine, secreted protein acidic and rich in cysteine (SPARC), suppresses colon tumorigenesis via regular exercise. Gut. 2013;62:882–9.

    Article  CAS  Google Scholar 

  21. Ryan AM, Reynolds JV, Healy L, et al. Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: results of a double-blinded randomized controlled trial. Ann Surg. 2009;249:355–63.

    Article  Google Scholar 

  22. Kudou K, Saeki H, Nakashima Y, et al. Postoperative skeletal muscle loss predicts poor prognosis of adenocarcinoma of upper stomach and esophagogastric junction. World J Surg. 2019;43:1068–75.

    Article  Google Scholar 

  23. Yamaoka Y, Fujitani K, Tsujinaka T, et al. Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy. Gastric Cancer. 2015;18:382–9.

    Article  CAS  Google Scholar 

  24. Okada G, Matsumoto Y, Nakamura Y, et al. Nutritional changes and factors contributing to postoperative weight recovery after esophagectomy. Esophagus. 2017;14:343–50.

    Article  Google Scholar 

  25. Kobayashi A, Kaido T, Hamaguchi Y, et al. Impact of postoperative changes in sarcopenic factors on outcomes after hepatectomy for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci. 2016;23:57–64.

    Article  Google Scholar 

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Acknowledgment

This work was not supported by any grant support or funding. This work was supported in part by a Grant-in-Aid from the Ministry of Education.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yuichiro Nakashima MD, PhD, Qingjiang Hu MD, PhD, Yasuo Tsuda MD, PhD, Yoko Zaitsu MD, PhD, Yuichi Hisamatsu MD, PhD, Koji Ando MD, PhD, Yasue Kimura MD, PhD, Eiji Oki MD, PhD, FACS & Masaki Mori MD, PhD, FACS

  2. Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan

    Hiroshi Saeki MD, PhD, FACS

Authors
  1. Yuichiro Nakashima MD, PhD
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  2. Hiroshi Saeki MD, PhD, FACS
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  3. Qingjiang Hu MD, PhD
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  4. Yasuo Tsuda MD, PhD
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  5. Yoko Zaitsu MD, PhD
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  6. Yuichi Hisamatsu MD, PhD
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  7. Koji Ando MD, PhD
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  8. Yasue Kimura MD, PhD
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  9. Eiji Oki MD, PhD, FACS
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  10. Masaki Mori MD, PhD, FACS
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Corresponding author

Correspondence to Yuichiro Nakashima MD, PhD.

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Supplementary material 1 (DOCX 38 kb)

10434_2019_7850_MOESM2_ESM.tif

Figure S1. Kaplan–Meier DSS curves for patients with different degrees of skeletal muscle loss in the preoperative non-sarcopenia cohort (a) and preoperative sarcopenia cohort (b). Supplementary material 2 (TIFF 99 kb)

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Nakashima, Y., Saeki, H., Hu, Q. et al. Skeletal Muscle Loss After Esophagectomy Is an Independent Risk Factor for Patients with Esophageal Cancer. Ann Surg Oncol 27, 492–498 (2020). https://doi.org/10.1245/s10434-019-07850-6

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  • DOI: https://doi.org/10.1245/s10434-019-07850-6

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