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

Ozawa, Soji; Ishiyama, K.; Daiko, Hiroyuki

doi:10.1002/ags3.12603

Cited by 7 publications

(4 citation statements)

References 65 publications

(127 reference statements)

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“…Hence, omitting the non-fluorescent LN resection should be indicated only to avoid postoperative recurrent nerve paralysis in exchange for the possibility of remaining metastatic LNs. Furthermore, several recent studies have suggested the association of preoperative sarcopenia with the development of dysphagia after esophagectomy [ 38 , 39 ]. In patients with advanced cancer with severe sarcopenia, preventing postoperative malnutrition due to dysphagia may have a higher priority than performing the complete LN dissection.…”

Section: Discussionmentioning

confidence: 99%

Lymphatic flow mapping using near-infrared fluorescence imaging with indocyanine green helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer not treated with neoadjuvant chemotherapy

Shiomi,

Yagi,

Iwata

et al. 2023

Surg Endosc

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Background Lymphatic flow mapping using near-infrared fluorescence (NIR) imaging with indocyanine green (ICG) has been used for the intraoperative prediction of lymph node metastasis in esophageal or esophagogastric junction cancer. However, a consistent method that yields sufficient diagnostic quality is yet to be confirmed. This study explored the diagnostic utility of our newly established lymphatic flow mapping protocol for predicting lymph node metastasis in patients with esophageal or esophagogastric junction cancer. Methods We injected 0.5 mL of ICG (500 μg/mL) into the submucosal layer at four peritumoral points on the day before surgery for 54 patients. We performed lymphatic flow mapping intraoperatively using NIR imaging. After determining the NIR status and presence of metastases, evaluable lymph node stations on in vivo imaging and all resected lymph nodes were divided into four categories: ICG+meta+ (true positive), ICG+meta− (false positive), ICG−meta+ (false negative), and ICG−meta− (true negative). Results The distribution of ICG+ and meta+ lymph node stations differed according to the primary tumor site. Sensitivity and specificity for predicting meta+ lymph nodes among ICG+ ones were 50% (95% CI 41–59%) and 75% (73–76%), respectively. Predicting meta+ lymph node stations among ICG+ stations improved these values to 66% (54–77%) and 77% (74–79%), respectively. Undergoing neoadjuvant chemotherapy was an independent risk factor for having meta+ lymph nodes with false-negative diagnoses (odds ratio 4.82; 95% CI 1.28–18.19). The sensitivity of our technique for predicting meta+ lymph nodes and meta+ lymph node stations in patients who did not undergo neoadjuvant chemotherapy was 79% (63–90%) and 83% (61–94%), respectively. Conclusion Our protocol potentially helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer undergoing esophagectomy who did not undergo neoadjuvant chemotherapy. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Lymphatic flow mapping using near-infrared fluorescence imaging with indocyanine green helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer not treated with neoadjuvant chemotherapy

Shiomi,

Yagi,

Iwata

et al. 2023

Surg Endosc

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“…However, no consistent data regarding the degree or severity are available, limiting their value for individual risk prediction. 7,8 In this context, medical imaging may be a promising tool for opportunistic risk assessment in routine postoperative staging computed tomography (CT) on the basis of changes in the anatomy that may be more sensitive and accurate than traditional risk factors. 9 In particular, CT-derived changes in body composition (BC; ie, subcutaneous adipose tissue [SAT], visceral adipose tissue [VAT], and skeletal muscle [SM]) from routine staging may serve as a robust and low-cost prognostic tool in patients with GEAC without the need for additional testing.…”

Section: Introductionmentioning

confidence: 99%

Association Between Body Composition and Survival in Patients With Gastroesophageal Adenocarcinoma: An Automated Deep Learning Approach

Jung,

Diallo,

Scheef

et al. 2024

JCO Clin Cancer Inform

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PURPOSE Body composition (BC) may play a role in outcome prognostication in patients with gastroesophageal adenocarcinoma (GEAC). Artificial intelligence provides new possibilities to opportunistically quantify BC from computed tomography (CT) scans. We developed a deep learning (DL) model for fully automatic BC quantification on routine staging CTs and determined its prognostic role in a clinical cohort of patients with GEAC. MATERIALS AND METHODS We developed and tested a DL model to quantify BC measures defined as subcutaneous and visceral adipose tissue (VAT) and skeletal muscle on routine CT and investigated their prognostic value in a cohort of patients with GEAC using baseline, 3-6-month, and 6-12-month postoperative CTs. Primary outcome was all-cause mortality, and secondary outcome was disease-free survival (DFS). Cox regression assessed the association between (1) BC at baseline and mortality and (2) the decrease in BC between baseline and follow-up scans and mortality/DFS. RESULTS Model performance was high with Dice coefficients ≥0.94 ± 0.06. Among 299 patients with GEAC (age 63.0 ± 10.7 years; 19.4% female), 140 deaths (47%) occurred over a median follow-up of 31.3 months. At baseline, no BC measure was associated with DFS. Only a substantial decrease in VAT >70% after a 6- to 12-month follow-up was associated with mortality (hazard ratio [HR], 1.99 [95% CI, 1.18 to 3.34]; P = .009) and DFS (HR, 1.73 [95% CI, 1.01 to 2.95]; P = .045) independent of age, sex, BMI, Union for International Cancer Control stage, histologic grading, resection status, neoadjuvant therapy, and time between surgery and follow-up CT. CONCLUSION DL enables opportunistic estimation of BC from routine staging CT to quantify prognostic information. In patients with GEAC, only a substantial decrease of VAT 6-12 months postsurgery was an independent predictor for DFS beyond traditional risk factors, which may help to identify individuals at high risk who go otherwise unnoticed.

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“…10,14 Sarcopenia-and malnutrition-associated dysphagia contribute to respiratory adverse events after surgery. 15 However, the association between these factors and post-ESD pneumonia in patients with superficial esophageal cancer has not been comprehensively studied. Furthermore, swallowing function assessment is complex and requires multidisciplinary partnership and comprehensive examination.…”

Section: Introductionmentioning

confidence: 99%

“…Regarding esophageal cancer, ESD can cause an increase in esophageal pressure and dysphagia 10,14 . Sarcopenia‐ and malnutrition‐associated dysphagia contribute to respiratory adverse events after surgery 15 . However, the association between these factors and post‐ESD pneumonia in patients with superficial esophageal cancer has not been comprehensively studied.…”

Section: Introductionmentioning

confidence: 99%

Impact of low pharyngeal/esophageal pressure associated with sarcopenia on postendoscopic submucosal dissection pneumonia in patients with superficial esophageal cancer

Taniguchi,

Ono,

Haraguchi

et al. 2023

Digestive Endoscopy

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ObjectivesThe aging population, including patients with superficial esophageal cancer, encounters critical dysphagia‐ and postoperative pneumonia‐related issues. Although endoscopic submucosal dissection (ESD) provides advantages over other modalities, older patients are at higher risk of postoperative pneumonia. Furthermore, the etiologies of pneumonia are complex and include patient‐ (such as sarcopenia) and treatment‐ (including ESD) related factors. Therefore, this study evaluated swallowing function in patients with superficial esophageal cancer and identified post‐ESD pneumonia‐associated factors.MethodsComprehensive swallowing function and sarcopenia were evaluated in patients pre‐ESD and 2 months post‐ESD using high‐resolution manometry and several swallowing studies by multiple experts. The effects of mucosal resection and sarcopenia on swallowing function changes post‐ESD, the relationship between preoperative swallowing function and sarcopenia, and the factors influencing postoperative pneumonia were investigated.ResultsTwenty patients were included in the study. Patients with preoperative sarcopenia had significantly lower pharyngeal/upper esophageal sphincter and tongue pressures than those without sarcopenia. However, ESD did not worsen pharyngeal or upper esophageal pressure. Post‐ESD pneumonia incidence tended to be higher in patients with sarcopenia than in those without sarcopenia. The lower upper esophageal sphincter‐integrated relaxation pressure (UES‐IRP) was a significant factor in pneumonia development. Furthermore, the receiver operating characteristic curve for UES‐IRP in pneumonia yielded an area under the curve of 0.82.ConclusionsSarcopenia is associated with preoperative dysphagia, which increases post‐ESD pneumonia risk. Therefore, postoperative pneumonia incidence is expected to increase with an aging population, making preoperative sarcopenia and swallowing function evaluation crucial.

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

Cited by 7 publications

References 65 publications

Lymphatic flow mapping using near-infrared fluorescence imaging with indocyanine green helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer not treated with neoadjuvant chemotherapy

Lymphatic flow mapping using near-infrared fluorescence imaging with indocyanine green helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer not treated with neoadjuvant chemotherapy

Association Between Body Composition and Survival in Patients With Gastroesophageal Adenocarcinoma: An Automated Deep Learning Approach

Impact of low pharyngeal/esophageal pressure associated with sarcopenia on postendoscopic submucosal dissection pneumonia in patients with superficial esophageal cancer

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