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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2019

01-05-2019 | Esophageal Cancer | Thoracic Oncology

Impact of Preoperative Skeletal Muscle Mass and Nutritional Status on Short-and Long-Term Outcomes After Esophagectomy for Esophageal Cancer: A Retrospective Observational Study

Impact of Psoas Muscle Mass and Body Mass on Esophagectomy

Authors: Toshiaki Shichinohe, MD, PhD, Shion Uemura, MD, Satoshi Hirano, MD, PhD, Masao Hosokawa, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2019

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Abstract

Background

Preoperative muscle volume and body mass index (BMI) are associated with postoperative outcomes. Because esophagectomy for esophageal cancer (EC) is associated with high morbidity and because EC has a poor prognosis, this study investigated the association of preoperative skeletal muscle mass and nutritional status with postoperative outcomes.

Methods

The study analyzed 483 patients who underwent esophagectomy from 2009 to 2012. The cross-sectional area of the psoas muscle index (PMI) was measured at the third lumbar vertebral level using computed tomography. Clavien–Dindo classifications were used to analyze postoperative complications. Because skeletal muscle mass varies according to sex, all analyses were performed accordingly (390 males, 93 females).

Results

For male patients, BMI was a significant multivariate factor, and PMI, a univariate factor, predicted postoperative complications and overall survival (OS). Using a preoperative nutritional and muscular (PNM) score derived from BMI and PMI results (patients were allocated 1 point if their BMI was < 18.5 kg/m2 and 1 point if their PMI was < 600 mm2/m2, for a possible maximum total of 2 points), male patients were categorized as high risk (score 2), moderate risk (score 1), or low risk (score 0). In the low-risk group, anastomotic leakage was significantly less (p = 0.01), and the 3-year OS was significantly better (p < 0.01). On the other hand, in female patients, neither BMI nor PMI was a significant factor for postoperative outcomes.

Conclusions

For male patients, the PNM score is a promising tool for predicting postoperative outcomes and identifying patients requiring preoperative nutritional intervention and rehabilitation.
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Metadata
Title
Impact of Preoperative Skeletal Muscle Mass and Nutritional Status on Short-and Long-Term Outcomes After Esophagectomy for Esophageal Cancer: A Retrospective Observational Study
Impact of Psoas Muscle Mass and Body Mass on Esophagectomy
Authors
Toshiaki Shichinohe, MD, PhD
Shion Uemura, MD
Satoshi Hirano, MD, PhD
Masao Hosokawa, MD, PhD
Publication date
01-05-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07188-z

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