The Evaluation of Sarcopenia before Neoadjuvant Chemotherapy Is Important for Predicting Postoperative Pneumonia in Patients with Esophageal Cancer

Abstract

Introduction: Sarcopenia is often observed in patients with esophageal cancer (EC). However, the influence of sarcopenia during neoadjuvant chemotherapy (NAC) on complications has not been fully investigated. Thus, we aimed to investigate the best way of evaluating sarcopenia for predicting complications, especially postoperative pneumonia (PP), in patients with EC undergoing NAC and esophagectomy. Methods: We retrospectively reviewed 36 patients. The skeletal muscle mass index (SMI) was evaluated by both BIA and CT. Patients were diagnosed with sarcopenia at pre-NAC and preoperatively. Different criteria were compared in terms of the predictability of PP. Next, we evaluated which factors were related to sarcopenia with best PP predictability. Finally, we investigated perioperative factors that were associated with SMI change during NAC. Results: PP occurred in three patients. Pre-NAC modified European Working Group on Sarcopenia in Older People (EWGSOP) criteria showed the best PP predictability. Low pre-NAC BMI and %VC were significantly associated with sarcopenia by the modified EWGSOP criteria. There was a trend that patients of the SMI non-increased group during NAC were more likely to develop PP. Conclusion: Pre-NAC sarcopenia by modified EWGSOP was a significant predictor of PP after esophagectomy. Appropriate interventions for these patients should be explored to prevent PP.

Correlation between sarcopenia and esophageal cancer: a narrative review

“…Based on the aforementioned studies, it is evident that sarcopenia independently indicates reduced overall survival [ 14 , 63 , 68 – 70 ], disease-free survival [ 40 , 71 ], and recurrence-free survival [ 14 ] in patients with esophageal cancer who undergo chemotherapy. Furthermore, sarcopenia increases the incidence of toxic reactions [ 66 , 67 ], mucositis, fever [ 71 ], and lymphopenia [ 70 ], consequently leading to perioperative complications [ 68 , 72 ], an elevated risk of postoperative recurrence rates [ 40 ], and postoperative mortality [ 73 ]. Early implementation of appropriate nutritional intervention prior to treatment may improve prognosis [ 74 ].…”

Protocol of a pilot randomized clinical trial to evaluate nutritional support and rehabilitation on prevention of skeletal muscle mass loss during neoadjuvant chemotherapy in patients with esophageal cancer

“…We have reported that preoperative sarcopenia based on the EWGSOP criteria is a significant indicator for predicting PP after esophagectomy in patients with EC [6] because the thoracic wall and abdominal muscles are critical for maintaining airway clearance. In addition, it has been shown that the skeletal muscle mass declines during NAC [7][8][9]. Thus, several approaches should be attempted to increase the skeletal muscle mass.…”

Psoas muscle mass index and peak expiratory flow as measures of sarcopenia: relation to outcomes of elderly patients with resectable esophageal cancer

“…However, previous investigations into sarcopenia in esophageal cancer have primarily focused on the diagnosis of reduced muscle mass, disregarding the evaluation of muscular strength ( 11 , 15 – 17 ). This disregard could be attributed to the laborious process of gauging muscle strength and the accompanying expenses.…”