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Loss of Skeletal Muscle Mass During Neoadjuvant Chemoradiotherapy Predicts Postoperative Mortality in Esophageal Cancer Surgery.

Reisinger KW, Bosmans JW, Uittenbogaart M, Alsoumali A, Poeze M, Sosef MN, Derikx JP - Ann. Surg. Oncol. (2015)

Bottom Line: Esophageal surgery is associated with complications and mortality.It was investigated whether this amount was associated with postoperative 30-day or in-hospital mortality and morbidity.In the complete cohort, no significant association between loss of muscle mass and mortality was found.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. k.reisinger@maastrichtuniversity.nl.

ABSTRACT

Background: Esophageal surgery is associated with complications and mortality. It is highly important to develop tools predicting unfavorable postoperative outcome. Esophageal cancer and neoadjuvant chemoradiotherapy (CRT) induce skeletal muscle wasting, which leads to diminished physiologic reserves. The purpose of this study was to investigate whether the degree of muscle mass lost during neoadjuvant CRT predicts postoperative mortality.

Methods: A total of 123 consecutive patients undergoing surgery for esophageal malignancy in the period 2008-2012 were included, of whom 114 received neoadjuvant CRT. Skeletal muscle mass was measured on routinely performed CT scans by assessing L3 muscle index (according to the Prado method) before and after neoadjuvant CRT, and the amount of muscle mass lost during neoadjuvant CRT (muscle loss index) was calculated. It was investigated whether this amount was associated with postoperative 30-day or in-hospital mortality and morbidity.

Results: In the complete cohort, no significant association between loss of muscle mass and mortality was found. However, skeletal muscle mass was significantly lower in patients with stage III-IV tumors compared with stage I-II tumors, prior to neoadjuvant CRT. In the stage III-IV subgroup, the amount of muscle mass lost during neoadjuvant CRT was predictive of postoperative mortality: -13.5 % (standard deviation 6.2 %) in patients who died postoperatively compared with -5.0 % (standard deviation 8.3 %) in surviving patients, p = 0.02.

Conclusions: Measurement of muscle mass loss during neoadjuvant chemoradiotherapy may provide a readily available and inexpensive assessment to identify patients at risk for developing unfavorable postoperative outcome after resection of esophageal malignancies, especially in patients with stage III-IV tumors.

No MeSH data available.


Related in: MedlinePlus

L3 muscle index before and after neoadjuvant CRT in patients undergoing esophageal surgery. a Patients with both a preCRT and a postCRT CT scan (n = 96). b By tumor stage: stage III–IV (n = 52) versus I–II (n = 44)
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Fig1: L3 muscle index before and after neoadjuvant CRT in patients undergoing esophageal surgery. a Patients with both a preCRT and a postCRT CT scan (n = 96). b By tumor stage: stage III–IV (n = 52) versus I–II (n = 44)

Mentions: A total of 123 patients were included, of whom 101 (82 %) were males; 114 patients received neoadjuvant CRT. Both a preCRT and postCRT CT scan were available in 96 patients. Patient, tumor, and operation characteristics are presented in Table 1. An explanatory flowchart of patients, including those receiving CRT and availability of CT scans, is presented in Diagram 1. Sarcopenia was present in 60 of 108 patients (56 %) before CRT and in 74 of 111 patients (67 %) after CRT. Concomitantly, the mean L3-index decreased significantly during CRT, which was measured in patients with both a preCRT and a postCRT CT scan [50.9 (SD, 8.5) cm2/m2 to 48.4 (8.5) cm2/m2, p < 0.001; Fig. 1a]. In male subjects, the L3-index decreased from 53.4 (7.8) to 49.5 (7.9) cm2/m2, p < 0.001, and in female subjects the L3-index decreased from 42.7 (5.4) to 39.7 (4.4) cm2/m2, p = 0.02. Mortality within 30 days or within hospital admission was 11 of 123 (9 %) in the total cohort and 6 of 62 (10 %) in patients with stage III-IV tumors. Of note, only stage IV patients who responded well to CRT and were classified as stage III after CRT were eligible for surgery.Of patients with both a preCRT and postCRT CT scan, mortality rates were 9 of 96 (9 %) and 5 of 52 (10 %), respectively. Causes of mortality are listed in Table 2.Table 1


Loss of Skeletal Muscle Mass During Neoadjuvant Chemoradiotherapy Predicts Postoperative Mortality in Esophageal Cancer Surgery.

Reisinger KW, Bosmans JW, Uittenbogaart M, Alsoumali A, Poeze M, Sosef MN, Derikx JP - Ann. Surg. Oncol. (2015)

L3 muscle index before and after neoadjuvant CRT in patients undergoing esophageal surgery. a Patients with both a preCRT and a postCRT CT scan (n = 96). b By tumor stage: stage III–IV (n = 52) versus I–II (n = 44)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig1: L3 muscle index before and after neoadjuvant CRT in patients undergoing esophageal surgery. a Patients with both a preCRT and a postCRT CT scan (n = 96). b By tumor stage: stage III–IV (n = 52) versus I–II (n = 44)
Mentions: A total of 123 patients were included, of whom 101 (82 %) were males; 114 patients received neoadjuvant CRT. Both a preCRT and postCRT CT scan were available in 96 patients. Patient, tumor, and operation characteristics are presented in Table 1. An explanatory flowchart of patients, including those receiving CRT and availability of CT scans, is presented in Diagram 1. Sarcopenia was present in 60 of 108 patients (56 %) before CRT and in 74 of 111 patients (67 %) after CRT. Concomitantly, the mean L3-index decreased significantly during CRT, which was measured in patients with both a preCRT and a postCRT CT scan [50.9 (SD, 8.5) cm2/m2 to 48.4 (8.5) cm2/m2, p < 0.001; Fig. 1a]. In male subjects, the L3-index decreased from 53.4 (7.8) to 49.5 (7.9) cm2/m2, p < 0.001, and in female subjects the L3-index decreased from 42.7 (5.4) to 39.7 (4.4) cm2/m2, p = 0.02. Mortality within 30 days or within hospital admission was 11 of 123 (9 %) in the total cohort and 6 of 62 (10 %) in patients with stage III-IV tumors. Of note, only stage IV patients who responded well to CRT and were classified as stage III after CRT were eligible for surgery.Of patients with both a preCRT and postCRT CT scan, mortality rates were 9 of 96 (9 %) and 5 of 52 (10 %), respectively. Causes of mortality are listed in Table 2.Table 1

Bottom Line: Esophageal surgery is associated with complications and mortality.It was investigated whether this amount was associated with postoperative 30-day or in-hospital mortality and morbidity.In the complete cohort, no significant association between loss of muscle mass and mortality was found.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. k.reisinger@maastrichtuniversity.nl.

ABSTRACT

Background: Esophageal surgery is associated with complications and mortality. It is highly important to develop tools predicting unfavorable postoperative outcome. Esophageal cancer and neoadjuvant chemoradiotherapy (CRT) induce skeletal muscle wasting, which leads to diminished physiologic reserves. The purpose of this study was to investigate whether the degree of muscle mass lost during neoadjuvant CRT predicts postoperative mortality.

Methods: A total of 123 consecutive patients undergoing surgery for esophageal malignancy in the period 2008-2012 were included, of whom 114 received neoadjuvant CRT. Skeletal muscle mass was measured on routinely performed CT scans by assessing L3 muscle index (according to the Prado method) before and after neoadjuvant CRT, and the amount of muscle mass lost during neoadjuvant CRT (muscle loss index) was calculated. It was investigated whether this amount was associated with postoperative 30-day or in-hospital mortality and morbidity.

Results: In the complete cohort, no significant association between loss of muscle mass and mortality was found. However, skeletal muscle mass was significantly lower in patients with stage III-IV tumors compared with stage I-II tumors, prior to neoadjuvant CRT. In the stage III-IV subgroup, the amount of muscle mass lost during neoadjuvant CRT was predictive of postoperative mortality: -13.5 % (standard deviation 6.2 %) in patients who died postoperatively compared with -5.0 % (standard deviation 8.3 %) in surviving patients, p = 0.02.

Conclusions: Measurement of muscle mass loss during neoadjuvant chemoradiotherapy may provide a readily available and inexpensive assessment to identify patients at risk for developing unfavorable postoperative outcome after resection of esophageal malignancies, especially in patients with stage III-IV tumors.

No MeSH data available.


Related in: MedlinePlus