Usefulness of skeletal muscle measurement by computed tomography in patients with esophageal cancer: changes in skeletal muscle mass due to neoadjuvant therapy and the effect on the prognosis

Association of Preoperative Sarcopenia with the Risk of Anastomotic Leakage in Surgical Esophageal Cancer Patients: A Meta-Analysis

BACKGROUND

Whether preoperative sarcopenia predicts increased risk of anastomotic leakage in operated esophageal cancer patients remains unclear. This study aimed to identify the relationship between preoperative sarcopenia and the incidence of anastomotic leakage in surgical esophageal cancer.

METHODS

PubMed, EMBASE, CNKI and Web of Science databases were searched up to October 11, 2024. Odds ratios (ORs) and 95% confidence intervals (CIs) were combined and subgroup analysis based on the pathological type, definition of sarcopenia and history of neoadjuvant therapy were performed.

RESULTS

Fifteen studies with 3,785 patients were included and 368 patients developed the anastomotic leakage (9.72%). Pooled results demonstrated that preoperative sarcopenia was significantly associated with the occurrence of anastomotic leakage among surgical esophageal cancer patients (OR = 1.57, 95% CI: 1.29-1.90, p < 0.001). Subgroup analysis by the pathological type and definition of sarcopenia revealed similar results. However, subgroup analysis by the neoadjuvant therapy indicated that preoperative sarcopenia was only related to anastomotic leakage among patients without the history of neoadjuvant therapy (OR = 2.40. 95% CI: 1.61-3.58, p < 0.001), and sarcopenia was not a significant risk factor for anastomotic leakage in neoadjuvant therapy treated patients (OR = 1.06, p = 0.845).

CONCLUSION

Preoperative sarcopenia could serve as a risk indicator in surgical esophageal cancer patients without neoadjuvant therapy.

Correlation between sarcopenia and esophageal cancer: a narrative review

BACKGROUND

In recent years, the research on the relationship between sarcopenia before and after the treatment of esophageal cancer, as well as its impact on prognosis of esophageal cancer, has increased rapidly, which has aroused people's attention to the disease of patients with esophageal cancer complicated with sarcopenia. This review examines the prevalence of sarcopenia in patients with esophageal cancer, as well as the relationship between sarcopenia (before and after surgery or chemotherapy) and prognosis in patients with esophageal cancer. Moreover, we summarized the potential pathogenesis of sarcopenia and pharmacologic and non-pharmacologic therapies.

METHODS

A narrative review was performed in PubMed and Web of Science using the keywords ("esophageal cancer" or "esophageal neoplasm" or "neoplasm, esophageal" or "esophagus neoplasm" or "esophagus neoplasms" or "neoplasm, esophagus" or "neoplasms, esophagus" or "neoplasms, esophageal" or "cancer of esophagus" or "cancer of the esophagus" or "esophagus cancer" or "cancer, esophagus" or "cancers, esophagus" or "esophagus cancers" or "esophageal cancer" or "cancer, esophageal" or "cancers, esophageal" or "esophageal cancers") and ("sarcopenia" or "muscular atrophy" or "aging" or "senescence" or "biological aging" or "aging, biological" or "atrophies, muscular" or "atrophy, muscular" or "muscular atrophies" or "atrophy, muscle" or "atrophies, muscle" or "muscle atrophies"). Studies reporting relationship between sarcopenia and esophageal cancer were analyzed.

RESULTS

The results of the review suggest that the average prevalence of sarcopenia in esophageal cancer was 46.3% ± 19.6% ranging from 14.4 to 81% and sarcopenia can be an important predictor of poor prognosis in patients with esophageal cancer. Patients with esophageal cancer can suffer from sarcopenia due to their nutritional deficiencies, reduced physical activity, chemotherapy, and the effects of certain inflammatory factors and pathways. When classic diagnostic values for sarcopenia such as skeletal muscle index (SMI) are not available clinically, it is also feasible to predict esophageal cancer prognosis using simpler metrics, such as calf circumference (CC), five-count sit-up test (5-CST), and six-minute walk distance (6MWD).

CONCLUSIONS

Identifying the potential mechanism of sarcopenia in patients with esophageal cancer and implementing appropriate interventions may hold the key to improving the prognosis of these patients.