Decreased core muscle size is associated with worse patient survival following esophagectomy for cancer

Sheetz, Kyle H.; Zhao, Lili; Holcombe, Sven A.; Wang, S. C.; Reddy, Rishindra M.; Lin, Jules; Orringer, Mark B.; Chang, Andrew C.

doi:10.1111/dote.12020

Cited by 66 publications

(97 citation statements)

References 30 publications

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“…This is in agreement with the work of authors in other surgical disciplines. 3,7,12,13,17,18,22,24 The association with preoperative psoas size and postoperative morbidity is especially apparent in male patients. It is important to note that our morphometric analysis was not predictive or statistically significant in female patients.…”

Section: Discussionmentioning

confidence: 99%

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Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

Zakaria¹,

Schultz

Mossa-Basha

et al. 2015

FOC

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OBJECT Improved objective assessments of perioperative risk after spine surgery are necessary to decrease postoperative morbidity and mortality rates. Morphometric analysis has proven utility in predicting postoperative morbidity and mortality in surgical disciplines. The aim of the present study was to evaluate whether morphometrics can be applied to the cases of patients undergoing lumbar spine surgery. METHODS The authors performed a retrospective review of the perioperative course of 395 patients who underwent lumbar surgery at their institution from 2013 to 2014. Preoperative risk factors such as age, diabetes, smoking, coronary artery disease, and body mass index (BMI) were recorded. Preoperative MRI was used to measure the psoas muscle area at the L-4 vertebra and paraspinal muscle area at the T-12 vertebra. Primary outcomes included unplanned return to the operating room, 30- and 90-day readmissions, surgical site infection, wound dehiscence, new neurological deficit, deep vein thrombosis, pulmonary embolism, myocardial infarction, urinary tract infection, urinary retention, hospital-acquired pneumonia, stroke, and prolonged stay in the intensive care unit. RESULTS The overall rate of adverse events was 30%, the most common event being urinary retention (12%). Greater age (p = 0.015) and tobacco usage (p = 0.026) were both significantly associated with complications for all patients, while diabetes, coronary artery disease, and high BMI were not. No surgery-related characteristics were associated with postoperative morbidity, including whether surgery required instrumentation, whether it was a revision, or the number of vertebral levels treated. Using multivariate regression analysis, male and female patients with the lowest psoas tertile had an OR of 1.70 (95% CI 1.04–2.79, p = 0.035) for having postoperative complications. Male patients in the lowest psoas tertile had an OR of 2.42 (95% CI 1.17–5.01, p = 0.016) for having a postoperative complication. The paraspinal muscle groups did not provide any significant data for postoperative morbidity, even after multivariate analysis. CONCLUSIONS The morphometric measurement of psoas muscle size may be a sensitive predictive tool compared with other risk factors for perioperative morbidity in male patients undergoing lumbar surgery.

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Section: Discussionmentioning

confidence: 99%

“…Morphometric analysis has proven utility in predicting postoperative morbidity and mortality following major general, vascular, and transplant surgery. 2,4,6,7,12,13,17,18,22,24,31 This study evaluates whether morphometrics can be used as a reliable predictor of perioperative morbidity in patients undergoing lumbar spine surgery.…”

mentioning

confidence: 99%

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

Zakaria¹,

Schultz

Mossa-Basha

et al. 2015

FOC

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“…More specifically, patients with weak handgrip strength had higher risk of complications and mortality after elective esophagectomy [43]. Decreased muscle mass, assessed by preoperative computed tomography scans, seems to be an independent predictor of both overall survival (Figure 1) [44] and disease-free survival, as significant as tumor stage, in patients following esophagectomy [45,46]. In addition, sarcopenic patients who underwent esophagectomy had significantly higher rate of respiratory complications compared to nonsarcopenic subjects, but there was no difference in the incidence of overall complications between the two groups [47][48][49].…”

Section: Sarcopenia and Cancer Cachexiamentioning

confidence: 96%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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Esophageal cancer is associated with malnutrition in the vast majority of patients. This phenomenon is partly attributed to the disease process itself, the location of the tumor and other factors, such as dysphagia which is often accentuated due to chemotherapy/ radiotherapy treatment or surgical intervention. The poor nutritional status of these patients is often related to the presence of cancer cachexia, altered metabolism, and tissue wasting. Malnutrition in this patient population affects quality of life, worsens patient's tolerance to chemotherapy and accounts for lower survival. Nutritional management of these patients includes both proper nutritional assessment and support and might prevent, to a certain extent, the manifestation of malnutrition-related consequences. The purpose of this article is to review the current literature in order to focus on the etiology and diagnosis of malnutrition in esophageal cancer patients, emphasizing also on the optimal nutritional support during multimodality treatment.

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“…ers of frailty, namely sarcopenia, have been successfully used to predict postoperative morbidity and mortality following major surgery, 9,10,17,28,40,46,56 including lumbar spine surgery. 57 Morphometrics is the measurement of patient attributes that are indicative of sarcopenia and, by extension, frailty.…”

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confidence: 99%

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Zakaria¹,

Basheer²,

Boyce-Fappiano

et al. 2016

FOC

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OBJECTIVE Predicting the survival rate for patients with cancer is currently performed using the TNM Classification of Malignant Tumors (TNM). Identifying accurate prognostic markers of survival would allow better treatment stratification between more aggressive treatment strategies or palliation. This is especially relevant for patients with spinal metastases, who all have identical TNM staging and whose surgical decision-making is potentially complex. Analytical morphometrics quantifies patient frailty by measuring lean muscle mass and can predict risk for postoperative morbidity after lumbar spine surgery. This study evaluates whether morphometrics can be predictive of survival in patients with spinal metastases. METHODS Utilizing a retrospective registry of patients with spinal metastases who had undergone stereotactic body radiation therapy, the authors identified patients with primary lung cancer. Morphometric measurements were taken of the psoas muscle using CT of the lumbar spine. Additional morphometrics were taken of the L-4 vertebral body. Patients were stratified into tertiles based on psoas muscle area. The primary outcome measure was overall survival, which was measured from the date of the patient's CT scan to date of death. RESULTS A total of 168 patients were identified, with 54% male and 54% having multiple-level metastases. The median survival for all patients was 185.5 days (95% confidence interval [CI] 146–228 days). Survival was not associated with age, sex, or the number of levels of metastasis. Patients in the smallest tertile for the left psoas area had significantly shorter survival compared with a combination of the other two tertiles: 139 days versus 222 days, respectively, hazard ratio (HR) 1.47, 95% CI 1.06–2.04, p = 0.007. Total psoas tertiles were not predictive of mortality, but patients whose total psoas size was below the median size had significantly shorter survival compared with those greater than the median size: 146 days versus 253.5 days, respectively, HR 1.43, 95% CI 1.05–1.94, p = 0.025. To try to differentiate small body habitus from frailty, the ratio of psoas muscle area to vertebral body area was calculated. Total psoas size became predictive of mortality when normalized to vertebral body ratio, with patients in the lowest tertile having significantly shorter survival (p = 0.017). Left psoas to vertebral body ratio was also predictive of mortality in patients within the lowest tertile (p = 0.021). Right psoas size was not predictive of mortality in any calculations. CONCLUSIONS In patients with lung cancer metastases to the spine, morphometric analysis of psoas muscle and vertebral body size can be used to identify patients who are at risk for shorter survival. This information should be used to select patients who are appropriate candidates for surgery and for the tailoring of oncological treatment regimens.

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Decreased core muscle size is associated with worse patient survival following esophagectomy for cancer

Cited by 66 publications

References 30 publications

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

Nutritional Management of Esophageal Cancer Patients

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

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