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.