Impact of Preoperative Sarcopenia on Survival and Postoperative Outcomes in Esophageal Cancer Patients Undergoing Esophagectomy: A Single-Center Retrospective Study.

Abstract

Background Sarcopenia is the progressive and generalized loss of skeletal muscle and its associated function. Whilst it is typically associated with advanced age, it is also prevalent in patients with chronic diseases including cancer. Patients with esophageal cancer are at high risk of developing malnutrition and sarcopenia due to impaired oral intake, the effects of neoadjuvant treatment, and cancer-related cachexia. Sarcopenia has been associated with worse postoperative outcomes. The aim of this study was to investigate the impacts sarcopenia had on the short- and long-term outcomes of patients undergoing esophagectomy in a regional Australian context. Methods A single-center retrospective analysis was performed for 48 patients who underwent esophagectomy, most of which were for esophageal cancer. All eligible patients received neoadjuvant treatment prior to surgery. Patients were classified as sarcopenic based on their calculated skeletal muscle index (SMI) on a preoperative computed tomography scan. SMI criteria for sarcopenia were <52.4 cm²/m² for males and <38.5 cm²/m² for females. Outcomes measured included overall and disease-free survival, postoperative complications, and length of hospital stay. Results Of the 44 patients who met inclusion criteria and underwent esophagectomy, 27 were sarcopenic based on preoperative computed tomography skeletal muscle measurements at L3. The average overall survival for the sarcopenic group was 20.1 months (95% CI 13.3-26.9) with a one-, two-, and three-year overall survival rate of 59.3%, 29.6%, and 22.2%, respectively. The non-sarcopenic group had an average overall survival rate of 28.8 months (95% CI 19.6-38.1) with a one-, two-, and three-year overall survival rate of 82.4%, 41.2%, and 29.4%, respectively. The average disease-free survival for the sarcopenic group was 14.1 months (95% CI 8.4-19.8) with a one-, two-, and three-year disease-free survival rate of 37.0%, 18.5%, and 11.1%, respectively. The average disease-free survival rate for the non-sarcopenic group was 27.2 months (95% CI 19.7-34.7) with a one-, two-, and three-year disease-free survival rate of 76.5%, 41.2%, and 29.4%, respectively. The sarcopenic group had an increased average length of hospital stay (23.9 days (CI 95% 16.5-31.3) vs. 14.6 days (95% CI 12.2-17.0)). A higher proportion of the sarcopenic patients had restricted dietary intake and required either pureed or enteral feeding (36% vs. 9%). No difference in postoperative complications was detected between the groups. Conclusions Patients with preoperative sarcopenia had a lower overall and disease-free survival and an increased length of hospital stay when compared with non-sarcopenic patients. Additionally, sarcopenic patients had a higher likelihood of requiring pureed or enteral feeds preoperatively.