Myosteatosis predicts higher complications and reduced overall survival following radical oesophageal and gastric cancer surgery.

Autor: Murnane LC; School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Department of Nutrition and Dietetics, Alfred Health, Melbourne, Australia. Electronic address: l.murnane@alfred.org.au., Forsyth AK; School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia., Koukounaras J; Department of Radiology, Alfred Health, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia., Pilgrim CH; Hepaticopancreaticobiliary Surgery Unit, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia., Shaw K; Department of Surgery, Monash University, Melbourne, Australia; Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia., Brown WA; Department of Surgery, Monash University, Melbourne, Australia; Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia., Mourtzakis M; Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada., Tierney AC; School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; School of Allied Health, And Health Implementation Science and Technology, Health Research Institute, University of Limerick, Limerick, Ireland., Burton PR; Department of Surgery, Monash University, Melbourne, Australia; Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2021 Sep; Vol. 47 (9), pp. 2295-2303. Date of Electronic Publication: 2021 Feb 19.
DOI: 10.1016/j.ejso.2021.02.008
Abstrakt: Introduction: Low muscle attenuation, as governed by increased intramuscular fat infiltration (myosteatosis), may associate with adverse surgical outcomes. We aimed to determine whether myosteatosis is associated with an increased risk of postoperative complications and reduced long-term survival after oesophago-gastric (OG) cancer surgery.
Methods: Patients who underwent radical OG cancer surgery with preoperative abdominal computed tomography (CT) imaging were included. Myosteatosis was evaluated using previously defined cut-points for low skeletal muscle attenuation measured by CT. Oncological, surgical, complications, and outcome data were obtained from a prospective database.
Results: Of 108 patients, 56% (n = 61) had myosteatosis. Patients with myosteatosis were older (69.1 ± 9.1 vs. 62.8 ± 9.8 years, p = 0.001) and had a similar body mass index (BMI) (23.4 ± 5.3 vs. 25.9 ± 6.7 kg/m 2 , p = 0.766) compared to patients with normal muscle attenuation. Patients with myosteatosis had a higher rate of anastomotic leaks (15% vs. 2%, p = 0.041). On multivariate analysis, myosteatosis was an independent predictor of overall (OR 3.03, 95% CI 1.31-6.99, p = 0.009) and severe complications (OR 4.33, 95% CI 1.26-14.9, p = 0.020). Patients with myosteatosis had reduced 5 year overall (54.1% vs. 83%, p = 0.004) and disease-free (55.2% vs. 87.2%, p = 0.007) survival.
Conclusion: Myosteatosis is associated with a significantly increased risk of overall and severe complications as well as substantially reduced long-term survival. Assessment of muscle attenuation provides analysis beyond standard anthropometrics and may form part of preoperative physiological staging tools used to improve surgical outcomes.
Competing Interests: Declaration of competing interest Lisa Murnane has received honorarium from Fresenius-Kabi and Nestle Health Science, outside of the submitted work. Prof. Wendy Brown has received grants from Johnson and Johnson, Medtronic, GORE and Novo Nordisc, and personal fees from GORE, Novo Nordisc and Merck Sharpe and Dohme, outside of the submitted work. For the remaining authors no conflicts of interest none were declared.
(Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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