Effect of Preoperative Body Composition on Postoperative Anastomotic Leakage in Oncological Ivor Lewis Esophagectomy—A Retrospective Cohort Study.

Autor: Herzberg, Jonas, Strate, Tim, Passlack, Leon, Guraya, Salman Yousuf, Honarpisheh, Human
Zdroj: Cancers; Dec2024, Vol. 16 Issue 24, p4217, 14p
Abstrakt: Simple Summary: Esophageal cancer surgery is associated with a high risk of postoperative complications such as anastomotic leakage (AL). Preoperative malnutrition is a potential risk factor but the best way to diagnose its status remains unclear. The use of preoperative CT scans to detect deficits in body composition such as a reduced skeletal muscle index (SMI) can help to identify high-risk patients for postoperative complications. This study aimed to analyze clinical data of 111 patients after esophagectomy by correlating their preoperative CT scans with postoperative outcomes. These data showed reduced SMI in patients with postoperative (AL) and a prolonged postoperative length of stay in hospital in this group. Background: Surgery for esophageal cancer has an associated high rate of postoperative complications such as anastomotic leakage (AL) and fistulas. Pre-operative sarcopenia as a loss of skeletal muscle mass and function is identified as a potential prognostic factor in determining the outcomes of oncological surgical resections for esophageal cancers. In this study, we evaluated the impact of body composition on postoperative complications in esophageal cancer surgery. Methods: In this cohort study, we analyzed patients' body composition at the level of the third lumbar vertebra on CT scans before Ivor Lewis resections for esophageal cancers between January 2015 and December 2022. Patients with a skeletal muscle index (SMI) ≤ 38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men were classified as sarcopenic. Postoperative complications were categorized following the Dindo–Clavien classification and included AL, postoperative pneumonia, length of hospital stay, and failure-to-rescue which were compared between the sarcopenic and non-sarcopenic patients. Results: From a group of 111 patients with Ivor Lewis esophagectomy, 70 patients (63.1%) were classified as sarcopenic based on the SMI and the previously published gender-specific cut-off values. AL occurred at 12.6% (5.6% in adenocarcinoma). Within the whole cohort, patients with AL had a significantly low SMI of 43.487 ± 8.088 vs. 48.668 ± 7.514; p = 0.012. Additionally, the SMI showed a negative correlation to the length of postoperative hospital stay (r = −0.204; p = 0.032; N = 111). The failure-to-rescue rate was higher in the group of sarcopenic patients (12.8% vs. 8%). Conclusions: Our data showed a correlation between SMI and AL. This effect could not be seen in gender-specific SMI. This study showed a lower failure-to-rescue rate in non-sarcopenic patients after Ivor Lewis esophagectomy. These findings underscore the crucial role of determining the preoperative nutritional and body composition status as measured by the preoperative CT scans. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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