Sarcopenia impacts perioperative and survival outcomes after esophagectomy for cancer: a multicenter study

Jin-Soo Park; Maxwell Colby; Doruk Seyfi; Steven Leibman; Jerome Martin Laurence; Garett Smith; Gregory Leighton Falk; Charbel Sandroussi

doi:10.1016/j.gassur.2024.03.001

Sarcopenia impacts perioperative and survival outcomes after esophagectomy for cancer: a multicenter study

J Gastrointest Surg. 2024 Mar 4:S1091-255X(24)00356-1. doi: 10.1016/j.gassur.2024.03.001. Online ahead of print.

Authors

Jin-Soo Park¹, Maxwell Colby², Doruk Seyfi³, Steven Leibman⁴, Jerome Martin Laurence⁵, Garett Smith⁴, Gregory Leighton Falk⁶, Charbel Sandroussi⁵

Affiliations

¹ Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery (RPA IAS), Sydney, Australia; School of Medicine, University of Notre Dame, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia. Electronic address: jinsoopark91@gmail.com.
² Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Department of Radiology, Royal North Shore Hospital, Sydney, Australia.
³ Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia.
⁴ Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia.
⁵ Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery (RPA IAS), Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.
⁶ Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia.

PMID: 38548573
DOI: 10.1016/j.gassur.2024.03.001

Abstract

Background: The impact of sarcopenia on outcomes after esophagectomy is controversial. Most data are currently derived from Asian populations. This study aimed to correlate sarcopenia to short-term perioperative complication rates and long-term survival and recurrence outcomes.

Methods: A retrospective analysis was performed of patients undergoing esophagectomy for cancer from 3 tertiary referral centers in Australia. Sarcopenia was defined using cutoffs for skeletal muscle index (SMI), assessed on preoperative computed tomography images. Outcomes measured included complications, overall survival (OS), and disease-free survival (DFS).

Results: Of 462 patients (78.4% male; median age, 67 years), sarcopenia was evident in 276 (59.7%). Patients with sarcopenia had a higher rate of major (Clavien-Dindo ≥ 3b) complications (27.9% vs 14.5%; P < .001), including higher rates of postoperative cardiac arrythmia (16.3% vs 9.7%; P = .042), pneumonia requiring antibiotics (14.5% vs 9.1%; P = .008), and 30-day mortality (5.1% vs 0%; P = .002). In the sarcopenic group, the median OS was lower (37 months [95% CI, 27.1-46.9] vs 114 months [95% CI, 75.8-152.2]; P < .001), as was the median DFS (27 months [95% CI, 18.9-35.1] vs 77 months [95% CI, 36.4-117.6]; P < .001). Sarcopenia was an independent risk factor for lower survival on multivariate analysis (hazard ratio, 1.688; 95% CI, 1.223-2.329; P = .001).

Conclusion: Patients with preoperative sarcopenia based on analysis of SMI are at a higher risk of major complications and have inferior survival and oncologic outcomes after esophagectomy for esophageal cancer.

Keywords: Esophagus; Outcomes; Sarcopenia.