Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

Abstract

Background: The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery.Methods: The following items were retrospectively investigated. First, whether skeletal muscle loss occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in skeletal muscle loss in the postoperative acute phase of ESCC were investigated. Then, whether skeletal muscle loss in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC between January 2010 and June 2015 were retrospectively reviewed; 72 cases were eligible for this study. The total psoas major muscle mass index (TPI) at the level of the third lumbar vertebra (L3) was measured using computed tomography (CT) before surgery and three days after surgery. The long-term prognosis was estimated by the Kaplan-Meier method and the multivariate logistic regression model.Results: There was already a significant reduction of TPI in the acute phase up to POD 3 after ESCC surgery in comparison with the preoperative baseline TPI (P < 0.001). The TPI reduction rate was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The three-year overall survival rate was significantly different between the TPI reduction rate severe group and the TPI reduction rate mild group.Conclusion: skeletal muscle loss occurred even in the postoperative acute phase. Furthermore, it is very significant that skeletal muscle loss in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.

Laparoscopic liver resection is associated with less significant muscle loss than the conventional open approach

“…Compared to open gastrectomy, laparoscopic gastrectomy was associated with enhanced recovery of muscle mass at 6 months after surgery [45]. In addition, there were other studies revealing the protective effect of laparoscopic procedure on surgery-related muscle loss [26,46]. Furthermore, the current study found that serum albumin level on the 7th postoperative day was significantly lower in patients receiving open surgery.…”

“…Similar to pancreatic cancer, in which a higher preoperative CA 19-9 was associated with surgical-related muscle loss [22], we have discovered that a more advanced HCC in terms of AFP or tumor size could also result in more pronounced muscle loss after surgery. Since disease severity is intrinsic to tumors and can hardly be altered, we should thus try to optimize the modifiable variables, i.e., adoption of laparoscopic approach and avoidance of major complications, to minimize skeletal muscle loss after surgery [24,26,46]. From the current study, significant muscle loss could impact not only the perioperative recovery but also the oncological outcome.…”

Effect of different surgical approaches on the prognosis of patients with postoperative radiotherapy for stage IIB–IVA esophageal squamous cancer

“…Esophageal cancer is one of the most common malignant tumors in the world [1]. Due to the complex anatomical structure of the esophagus and numerous lymph nodes involved in removal, the rate of postoperative recurrence and metastasis after surgery is high [2,3].…”

Endothelial Damage and Muscle Wasting in Cardiac Surgery Patients

“…The well-documented occurrence of systemic inflammatory response syndrome (SIRS) after cardiac surgery, apart from its harmful action on the vascular endothelium, accelerates a profound endocrine-metabolic cascade that promotes hyper-catabolism [14][15][16][17], leading to skeletal muscle breakdown [4,18,19]. Although this hypercatabolic phase starts as early as the second postoperative day [14], in the short term, a wellnourished subject sustains minimal debilitation [19], to which, usually, no attention is paid, as long as the patient presents an uneventful postoperative course. However, this "uneventful" clinical outcome is commonly associated with measurable loss of muscle mass [4,18,19].…”