Looking beyond the eyeball test: A novel vitality index to predict recovery after esophagectomy

Commentary: Quantifying “fit for esophagectomy”—Grasping for more metrics

“…What do Tang and colleagues 1 add to what has already been established in the literature? Their work provides objective data, assessing patient physiologic function to define "frailty," and enhances a nebulous myriad of subjective assessments, measures, and scores, specifically in the context of evaluation for esophagectomy.…”

“…In this issue of the Journal, Tang and colleagues 1 present a single-institution prospective study of 77 patients to evaluate a novel composite measure of 4 physiologic metrics (grip strength, timed sit-stands, psoas muscle area to height ratio, and 6-minute walk distance) to predict perioperative outcomes following esophagectomy. The investigators' measure was then compared with 2 commonly used frailty indices.…”

“…Minimally invasive approaches to many disease processes, including esophageal cancer, can help lower the risk of morbidity and mortality. 1 Accurate preoperative assessment is a key component in stratifying patients who present to clinic for possible esophagectomy. These tools allow both medical oncologists and general thoracic surgeons the ability to predict the outcomes of various treatment plans, including multimodal therapy and esophagectomy, and identify nonsurgical candidates.…”

Association of frailty with clinical and financial outcomes of esophagectomy hospitalizations in the United States

“…Careful risk assessment is crucial to patient selection and shared decision-making when choosing treatment options for esophageal disease. Although a multitude of traditional models incorporate patient age and comorbidities to estimate perioperative risk, the concept of frailty has emerged as an important predictor of adverse events [ [1] , [2] , [3] ]. Mounting evidence has linked frailty with increased mortality, complications, and health care expenditures following major operations including coronary artery bypass grafting, lung resection, and colectomy [ [4] , [5] , [6] ].…”

Weighing in on Ghrelin and the Preservation of Muscle After Esophagectomy

“…1 Central to understanding and making meaningful headway on an operation demanding to the surgeon and markedly taxing to the patient is mitigating the loss of muscle mass, an independent factor in overall prognosis, which some have used as a preoperative predictor for outcomes. 2,3 Although the conventional philosophy of aggressive nutritional supplementation and early mobilization remain as fundamental underpinnings of perioperative success, there most assuredly are either undiscovered or only preliminarily explored adjunctive measures that can augment the intended effect of this traditional thinking. In this issue of Annals of Surgical Oncology, Nose et al 4 publish their thought-provoking results showing the effects of postoperative ghrelin administration on skeletal muscle loss after esophagectomy.…”