Loss of Skeletal Muscle Mass During Neoadjuvant Chemoradiotherapy Predicts Postoperative Mortality in Esophageal Cancer Surgery

Abstract

BackgroundEsophageal surgery is associated with complications and mortality. It is highly important to develop tools predicting unfavorable postoperative outcome. Esophageal cancer and neoadjuvant chemoradiotherapy (CRT) induce skeletal muscle wasting, which leads to diminished physiologic reserves. The purpose of this study was to investigate whether the degree of muscle mass lost during neoadjuvant CRT predicts postoperative mortality.MethodsA total of 123 consecutive patients undergoing surgery for esophageal malignancy in the period 2008–2012 were included, of whom 114 received neoadjuvant CRT. Skeletal muscle mass was measured on routinely performed CT scans by assessing L3 muscle index (according to the Prado method) before and after neoadjuvant CRT, and the amount of muscle mass lost during neoadjuvant CRT (muscle loss index) was calculated. It was investigated whether this amount was associated with postoperative 30-day or in-hospital mortality and morbidity.ResultsIn the complete cohort, no significant association between loss of muscle mass and mortality was found. However, skeletal muscle mass was significantly lower in patients with stage III–IV tumors compared with stage I–II tumors, prior to neoadjuvant CRT. In the stage III–IV subgroup, the amount of muscle mass lost during neoadjuvant CRT was predictive of postoperative mortality: −13.5 % (standard deviation 6.2 %) in patients who died postoperatively compared with −5.0 % (standard deviation 8.3 %) in surviving patients, p = 0.02.ConclusionsMeasurement of muscle mass loss during neoadjuvant chemoradiotherapy may provide a readily available and inexpensive assessment to identify patients at risk for developing unfavorable postoperative outcome after resection of esophageal malignancies, especially in patients with stage III–IV tumors.

Nutritional Management of Esophageal Cancer Patients

“…In another study, sarcopenia was present in 56 and 67% of patients before and after neoadjuvant chemoradiotherapy, respectively. This decrease in muscle mass was predictive of postoperative mortality in the stage III-IV subgroup of patients [99]. Furthermore, most of the radiotherapy-related toxicities are strongly associated with patient's nutritional status.…”

Decreased Skeletal Muscle Volume Is a Predictive Factor for Poorer Survival in Patients Undergoing Surgical Resection for Pancreatic Ductal Adenocarcinoma

“…14–23 However, definition of sarcopenia and means of the measurement of SM area varied among studies. Peng et al defined sarcopenia as a group of the patients in the lowest sex-specific quartile of the total psoas muscle index in the population, and showed that sarcopenia was associated with 3-year mortality after surgery for PDAC.…”

“…11–13 Sarcopenia can be objectively evaluated using a single slice of abdominal CT, and has increasingly been reported to be associated with poor survival or postoperative complications among various types of cancer patients. 14–23 …”

Skeletal Muscle Loss during Neoadjuvant Chemotherapy Is an Independent Risk Factor for Postoperative Infectious Complications in Patients with Advanced Esophageal Cancer

“…However, Ida et al [22] reported that changes in some body component parameters, including skeletal muscle, during NACT were correlated with the occurrence of postoperative complications. Reisinger et al [23] found that loss of muscle mass during neoadjuvant chemoradiotherapy was associated with postoperative mortality in patients with stage III-IV esophageal cancer. They speculated that more advanced tumors may increase the resting energy expenditure of the host, and patients with stage III or IV disease may be more prone to loss of muscle mass.…”