Association of preoperative sarcopenia with postoperative dysphagia in patients with thoracic esophageal cancer

Abstract

Summary Background The purpose of the current study was to clarify the relationship between clinical features of dysphagia after esophagectomy and preoperative sarcopenia. Methods A total of 187 cases were included in the current study. The psoas cross-sectional area on pre-treatment computed tomography was measured in thoracic esophageal cancer patients who underwent curative resection. The psoas muscle index (PMI) cut-off levels for sarcopenia were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Swallowing function was evaluated using videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) at postoperative days 7–15, and classified according to the food intake level scale (FILS). Perioperative swallowing rehabilitation was performed in all cases. Results In the 187 included patients, the median PMI was 5.42 cm2/m2 for men and 3.43 cm2/m2 for women, and 133 cases (71%) met the sarcopenia criteria. The FILS <4 (no oral intake) was 15% in the non-sarcopenia group, and 38% in the sarcopenia group (P = 0.003). There was no significant difference in the incidence of postoperative complications, including pneumonia and re-admission due to pneumonia, between the two groups. Preoperative sarcopenia and recurrent laryngeal nerve palsy were be independent risk factors for postoperative dysphagia. Conclusions Sarcopenic patients with esophageal cancer develop postoperative dysphagia more often than non-sarcopenic patients. Prehabilitation and nutritional support for patients with preoperative sarcopenia could play an important role to mitigate postoperative dysphagia.

Usefulness of the skeletal muscle index in postoperative ileus of colorectal cancer patients : a case control study

“…[16]. Furthermore, the association between sarcopenia and postoperative complications has also been reported in patients with other cancer types such as esophageal cancer, gastric cancer and pancreatic cancer [25][26][27][28].…”

Sarcopenia predicts an adverse prognosis in patients with combined hepatocellular carcinoma and cholangiocarcinoma after surgery

“…In our study, the cut-off values of the PMI for male and female individuals were 5.42 and 4.05 cm 2 /m 2 , respectively, which were comparable to previous studies in Asia. 46,47 F I G U R E 2 Subgroup analysis and test for interaction to evaluate the impact of sarcopenia on overall survival in cHCC-CC patients after surgery. AFP, alpha-fetoprotein; CA19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; HR, hazard ratio; LN, lymph node; OS, overall survival; p. inter, p value for interaction; Poorly/Undiff, low to undifferentiated; Well/Moder, well to moderately differentiated.…”

“…In our study, the cut‐off values of the PMI for male and female individuals were 5.42 and 4.05 cm 2 /m 2 , respectively, which were comparable to previous studies in Asia. 46 , 47 …”

Clinical significance of sarcopenic dysphagia for patients with esophageal cancer undergoing esophagectomy: A review

“… 23 , 24 Several patients with esophageal cancer are likely to be diagnosed as having sarcopenia, since many are elderly and have malnutrition or dysphagia. 25 Several reports have shown that preoperative sarcopenia is associated with postoperative pulmonary complications (PC) among patients undergoing surgery for esophageal cancer. 26 , 27 , 28 On the other hand, some reports have suggested that sarcopenia is not associated with PC after esophagectomy.…”

“…Mayanagi et al suggested that preoperative sarcopenia and laryngeal nerve palsy were independent risk factors of postoperative dysphagia in 187 patients with esophageal cancer in a retrospective study. 25 Katsumata et al reported that a reduction in geniohyoid muscle mass caused dysphagia in patients after surgery for esophageal cancer 57 ; furthermore, Yokoi et al suggested that a decrease in tongue pressure before and after surgery was significantly associated with postoperative pneumonia among inpatients with esophageal cancer after esophagectomy 58 (Table 2 ). These findings suggested that dysphagia after esophagectomy seemed to be related to factors associated with patient characteristics; therefore, perioperative interventions for patients with esophageal cancer might improve their swallowing function.…”