Preoperative low skeletal muscle mass as a risk factor for pharyngocutaneous fistula and decreased overall survival in patients undergoing total laryngectomy

Abstract

Background Low skeletal muscle mass (SMM) is associated with postoperative complications, prolonged hospital stay, and short overall survival (OS) in surgical oncology. We aimed to investigate this association in patients undergoing total laryngectomy (TL). Methods A retrospective study was performed of patients undergoing TL. SMM was measured using CT or MRI scans at the level of the third cervical vertebra (C3). Results In all, 235 patients were included. Low SMM was observed in 109 patients (46.4%). Patients with low SMM had more pharyngocutaneous fistulas (PCFs) than patients with normal SMM (34.9% vs 20.6%; P = .02) and prolonged hospital stay (median, 17 vs 14 days; P < .001). In multivariate analysis, low SMM (hazards ratio, 1.849; 95% confidence interval, 1.202‐2.843) and high N stage were significant prognosticators of decreased OS. Conclusion Low SMM is associated with PCF and prolonged hospital stay in patients undergoing TL. Low SMM is an independent prognostic factor for shorter OS.

Sarcopenia, a strong determinant for prolonged feeding tube dependency after chemoradiotherapy for head and neck cancer

“…The median neck SMI was 12 (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], and 61 patients (48%) became prolonged feeding tube-dependent (see Table 1).…”

“…In several cancer types, pretreatment sarcopenia is associated with inferior treatment outcomes including postoperative complications and treatment‐related toxicity . Recent studies confirm this association in head and neck cancer (HNC) with regard to treatment outcomes (ie, chemotherapy dose‐limiting toxicity) and survival after concomitant chemoradiotherapy (CRT) and postoperative complications including pharyngocutaneous fistula after total laryngectomy . There is a paucity of information, however, on the influence of sarcopenia on functional outcomes.…”

“…after concomitant chemoradiotherapy (CRT) and postoperative complications including pharyngocutaneous fistula after total laryngectomy. [9][10][11][12][13][14][15] There is a paucity of information, however, on the influence of sarcopenia on functional outcomes.…”

Impact of Sarcopenia on Outcomes of Autologous Head and Neck Free Tissue Reconstruction

“…1 However, a common theme that consistently emerges in its definition is the depletion of skeletal muscle mass with subsequent reduction in muscle strength and physical function. [2][3][4] The recent inclusion of sarcopenia as a defined disease entity in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10, M62.84) signifies the reappraisal of the role of body composition in disease progression and survival. 5 An emerging body of literature has vividly demonstrated sarcopenia as a negative prognostic factor in cancer patients.…”

“…[8][9][10][11] Interestingly, this phenomenon has only scarcely been investigated in patients undergoing of head and neck oncologic surgery despite the high-incidence of sarcopenia in the head and neck cancer (HNC) population. [2][3][4] It is even more striking that the impact of sarcopenia in autologous free tissue reconstruction of the head and neck has not been studied previously. Though factors, such as irradiation 12,13 and operative time, 14 have been identified as significant contributors to poor outcomes in autologous free tissue head and neck reconstruction, the role of sarcopenia in this realm has not been delineated.…”