The impact of preoperative sarcopenia on postoperative complications following esophagectomy for esophageal neoplasia: a systematic review and meta-analysis

Abstract

<jats:title>Summary</jats:title> <jats:p>Esophageal cancer is characterized by profound changes in body composition due to dysphagia and generalized cachexia. Sarcopenia or muscle wasting is a component of cachexia associated with poor postoperative performance status. The skeletal muscle index (SMI) calculated by computed tomography scans at the level of the third lumbar vertebra is an easily quantifiable and reproducible measure of sarcopenia. The aim of this meta-analysis is to investigate the impact of preoperative sarcopenia (low SMI) on postoperative complications after esophagectomy for neoplastic lesions. In this context, a comprehensive literature search was undertaken to identify studies reporting short-term postoperative outcomes in relation to their preoperative SMI values. Cumulative risk ratios (RR) and risk differences (RD) and their respective 95% confidence intervals (CIs) were calculated using a random-effect model. A total of 11 studies incorporating 1,979 total patients (964 patients with sarcopeniaversus 1,015 without sarcopenia) were included in the final analysis. The results demonstrated a significant increase in overall morbidity (RR 1.16, 95% CI 1.01–1.33), respiratory complications (RR 1.64, 95% CI 1.21–2.22) and anastomotic leaks (RR 1.39, 95% CI 1.10–1.76) in patients with sarcopenia. No statistically significant difference was noted in overall mortality (RD 0, 95% CI −0.02–0.02) or Clavien–Dindo grade III or greater complications (RR 1.17, 95% CI 0.96–1.42). The above results demonstrate the validity of the SMI as a predictive factor for post-esophagectomy complications. Although the risk associated with sarcopenia is not prohibitive for surgery, patients with low SMI require closer vigilance during their postoperative course due to the increased propensity for respiratory and anastomotic complications.</jats:p>

Clinical Significance of Pretreatment Red Blood Cell Distribution Width as a Predictive Marker for Postoperative Morbidity After Esophagectomy for Esophageal Cancer: A Retrospective Study

“…Other factors that could affect the incidence of postoperative morbidities were equivalent between the high and normal RDW groups. The same result was obtained in several studies reporting that pretreatment malnutrition increased postoperative morbidities in highly invasive gastroenterological procedures, such as esophagectomy, 25 – 27 pancreatoduodenectomy, 28 and rectal surgery. 29 …”

Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments

“…This disorder can be due to aging (primary sarcopenia) or acute and chronic illness (secondary sarcopenia), including chronic liver diseases [4]. Moreover, it has been associated with poor prognosis in a lot of malignancies as pancreatic cancer [6], colorectal liver metastases [7], melanoma [8], lung cancer [9] and esophageal neoplasia [10] and significantly increases morbidity and mortality after surgery for cancer [11], other than being associated with the outcome of patients with HCC [12]. In fact, sarcopenia has been associated with a higher rate of complications and recurrences in patients with cirrhosis and HCC undergoing resection [13].…”

Effect of Body Composition Change during Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma

“…In patients with stage II or III esophageal cancer, there are reports that pre-operative sarcopenia is associated with more perioperative complications [9,17] and poorer prognoses [4,8,[18][19][20]. There have been few reports on the effects of changes in the crossover between SMI and fat mass, especially for NAC in esophageal cancer.…”