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Sarcopenia and Short-Term Outcomes After Esophagectomy: A Meta-analysis

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

Abstract

Background

This meta-analysis aimed to investigate the value of preoperative sarcopenia in predicting complications after esophagectomy. Clinicopathologic characteristics of sarcopenia patients, which may support sarcopenia management, also were studied.

Methods

This study searched for articles describing an association between sarcopenia and short-term outcomes after esophagectomy using PubMed, EMBASE, and the Cochrane Library. Mantel–Haenszel and inverse variance models were used for the meta-analyses of end points.

Results

The meta-analysis included 14 studies comprising a total of 2387 patients. Sarcopenia was significantly associated with advanced age (weighted mean difference [WMD], 3.48; 95% confidence interval [CI], 2.22–4.74), lower body mass index (WMD − 2.22; 95% CI − 2.65 to − 1.79), squamous cell carcinoma (odds ratio [OR], 2.78; 95% CI 1.72–4.47), advanced clinical tumor stage (OR 1.65; 95% CI 1.28–2.15), and neoadjuvant therapy (OR 1.87; 95% CI 1.38–2.53). The sarcopenia patients showed lower preoperative albumin levels (WMD − 0.11; 95% CI − 0.19 to − 0.04) than the nonsarcopenia patients. Sarcopenia was significantly predictive of pneumonia (OR 2.58; 95% CI 1.75–3.81) and overall complications (OR 1.52; 95% CI 1.07–2.15) after esophagectomy. The sarcopenia patients also showed nonsignificant increases in the risks of anastomotic leakage (OR 1.29; 95% CI 0.99–1.67), vocal cord palsy (OR 2.03; 95% CI 0.89–4.64), and major complications (≥ Clavien-Dindo grade III; OR 1.30; 95% CI 0.95–1.79) but not increased operation time, blood loss, or mortality.

Conclusions

Preoperative sarcopenia assessment showed considerable potential for predicting postoperative complications for esophageal cancer patients. To realize this potential, more effective diagnostic criteria and severity classifications for sarcopenia are warranted.

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Acknowledgment

This work was funded by the Medical and Health Technology Innovation Project of the Chinese Academy of Medical Sciences (Grant No. 2018-12M-3-003) (Spatial–Temporal Mapping Analysis on Chinese Cancer Burden).

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Authors and Affiliations

  1. Department of Gastroenterology, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, Henan, China

    Pei-yu Wang MD, Li-dong Xu MD & Hui-li Wu MD

  2. Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xian-kai Chen MD, Lei Xu MD & Yin Li MD, PhD

  3. Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China

    Yong-kui Yu MD, Rui-xiang Zhang MD & Hai-bo Sun MD

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Correspondence to Yin Li MD, PhD.

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Wang, Py., Xu, Ld., Chen, Xk. et al. Sarcopenia and Short-Term Outcomes After Esophagectomy: A Meta-analysis. Ann Surg Oncol 27, 3041–3051 (2020). https://doi.org/10.1245/s10434-020-08236-9

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