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Sarcopenia and Patient’s Body Composition: New Morphometric Tools to Predict Clinical Outcome After Ivor Lewis Esophagectomy: a Multicenter Study

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Journal of Gastrointestinal Surgery

Abstract

Background

The impact of preoperative body composition as independent predictor of prognosis for esophageal cancer patients after esophagectomy is still unclear. The aim of the study was to explore such a relationship.

Methods

This is a multicenter retrospective study from a prospectively maintained database. We enrolled consecutive patients who underwent Ivor-Lewis esophagectomy in four Italian high-volume centers from May 2014. Body composition parameters including total abdominal muscle area (TAMA), visceral fat area (VFA), and subcutaneous fat area (SFA) were determined based on CT images. Perioperative variables were systematically collected.

Results

After exclusions, 223 patients were enrolled and 24.2% had anastomotic leak (AL). Sixty-eight percent of patients were sarcopenic and were found to be more vulnerable in terms of postoperative 90-day mortality (p = 0.028). VFA/TAMA and VFA/SFA ratios demonstrated a linear correlation with the Clavien-Dindo classification (R = 0.311 and 0.239, respectively); patients with anastomotic leak (AL) had significantly higher VFA/TAMA (3.56 ± 1.86 vs. 2.75 ± 1.83, p = 0.003) and VFA/SFA (1.18 ± 0.68 vs. 0.87 ± 0.54, p = 0.002) ratios. No significant correlation was found between preoperative BMI and subsequent AL development (p = 0.159). Charlson comorbidity index correlated significantly with AL (p = 0.008): these patients had a significantly higher index (≥ 5).

Conclusion

Analytical morphometric assessment represents a useful non-invasive tool for preoperative risk stratification. The concurrent association of sarcopenia and visceral obesity seems to be the best predictor of AL, far better than simple BMI evaluation, and potentially modifiable if targeted with prehabilitation programs.

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Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Andrea Cossu, Silvia Battaglia, Francesco Puccetti, Lavinia Barbieri, Lidia Ravizzini, Ugo Elmore & Riccardo Rosati

  2. Experimental Imaging Center, Radiology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Diego Palumbo, Chiara Gritti, Andrea Bettinelli & Francesco De Cobelli

  3. Division of General Surgery, Policlinico Di Abano Terme”, Padua, Italy

    Paolo Parise

  4. Department of Surgery, European Institute of Oncology IRCCS, Milan, Italy

    Stefano De Pascale, Manrica Fabbi, Giuseppe Roberto Bonfitto & Uberto Fumagalli Romario

  5. Department of General and Oncological Minimally-Invasive Surgery, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Monica Gualtierotti, Paolo De Martini & Giovanni Ferrari

  6. Division of Surgery, Department of Surgery, ASUFC “Santa Maria Della Misericordia”, Udine, Italy

    Massimo Vecchiato, Antonio Martino, Antonio Ziccarelli, Stefano Fapranzi & Roberto Petri

  7. Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Giulia Maria Scotti

  8. Division of Medical Imaging and Radiation Sciences, European Institute of Oncology, IEO, IRCCS, Milan, Italy

    Luigi Funicelli

  9. Italian Society of Medical and Interventional Radiology, SIRM, Italian College of Computed Tomography, Milan, Italy

    Luigi Funicelli

  10. Italian Society of Medical and Interventional Radiology, SIRM, Italian College of Oncology, Milan, Italy

    Luigi Funicelli

  11. Division of Surgery, Department of Surgery, DAME, University of Udine, Udine, Italy

    Alessandro Uzzau

Authors
  1. Andrea Cossu
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on behalf of SISME –Società Italiana per lo Studio delle Malattie dell’Esofago –Italian Society of disease of the esophagus

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Correspondence to Andrea Cossu.

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Cossu, A., Palumbo, D., Battaglia, S. et al. Sarcopenia and Patient’s Body Composition: New Morphometric Tools to Predict Clinical Outcome After Ivor Lewis Esophagectomy: a Multicenter Study. J Gastrointest Surg 27, 1047–1054 (2023). https://doi.org/10.1007/s11605-023-05611-1

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