Prognostic Significance of Skeletal Muscle Loss During Early Postoperative Period in Elderly Patients with Esophageal Cancer

Abstract

In this issue of Annals of Surgical Oncology, Takahashi et al. 1 report that skeletal muscle reduction in the highest tertile of their patient series was associated with worse cancer-free and overall survival after an oncologic esophagectomy. The patients were 65 years of age or older, had no cancer recurrence at 4 months, and had undergone R0 resections.The skeletal muscle index (SMI) analysis remained significant in the multivariate analysis for recurrence-free and overall survival. In fact, SMI loss in the highest tertile of patients had a hazard ratio (HR) of 5.405 for death (p \ 0.001; 95% confidence interval [CI], 3.514-8.314) and showed similar findings for recurrence-free survival. The patients with the highest tertile of skeletal muscle loss had more node-positive pathology at the time of resection, suggesting that the presence of microscopic disease may have correlated with the loss of skeletal muscle.Pre-therapeutic sarcopenia in esophageal cancers is highly prevalent as well as significantly and independently associated with postoperative complications, chemotherapy-induced toxicity, and poor survival in cancer patients, as shown in a recent systematic review. 2 Although we have no information on the use of postoperative enteral feeding and skeletal muscle index in this setting, enteral feeding has not demonstrated improvement in terms of postoperative weight loss. 3

Predicting Postoperative Skeletal Muscle Mass Loss in Patients with Gastric Cancer based on The Charlson Comorbidity Index

“…Previous studies have shown that the CCI and postoperative skeletal muscle mass loss are related to the survival prognosis of cancer patients, respectively [7,8,9,10,11]. Our study further proved the relationship between the CCI and postoperative skeletal muscle mass loss, and CCI ≥ 2 points is an independent risk factor for postoperative skeletal muscle mass loss.…”

“…Overall, patients with gastric cancer are prone to postoperative skeletal muscle mass loss for several reasons. Numerous studies have shown that postoperative skeletal muscle mass loss is an independent risk factor for recurrence and poor long-term survival in patients with gastric cancer [7,8,9,10].…”

The Impact of Preoperative Sarcopenia on Survival Prognosis in Patients Receiving Neoadjuvant Therapy for Esophageal Cancer: A Systematic Review and Meta-Analysis

“…Sarcopenia also have a significant correlation with age, which also an important risk factor for OS ( 29 , 30 ). We analyzed the relationship between age and OS for EC patients who diagnosed preoperative sarcopenia and received NAT.…”

Pattern Classification-Based Analysis on Gastrointestinal Multifunctional Apparatus Guided by Ultrasound Image after Resection of Esophageal Carcinoma

“…erefore, the postoperative recovery process of patients is very important in the treatment of esophageal cancer, which will directly affect the prognosis of patients. It has been shown that after clinical esophagectomy, the structure of the esophagus and stomach will be temporarily altered so that the stomach is lifted into the thoracic cavity and anastomosed with the residual esophagus, and the pressure in the thoracic cavity becomes negative, which reduces the pressure gradient between the stomach and duodenum in the Scientific Programming thoracic cavity and causes great pressure on the peristalsis and emptying of the gastrointestinal tract [16].…”