Highlighting sarcopenia management for promoting surgical outcomes in esophageal cancers: evidence from a prospective cohort study

Background: Studies have provided controversial and limited knowledge regarding the impact of sarcopenia on surgical outcomes in esophageal cancers due to retrospective study designs and single muscle-mass assessment. This prospective cohort study aimed to resolve these issues.

Methods: Bioelectrical impedance analysis, handgrip strength measurement, and the 4-meter walking test were conducted before surgery. Sarcopenia was diagnosed as low appendicular skeletal muscle mass index (<7.0 kg/m² in men and <5.7 kg/m² in women) plus low handgrip strength (<26 kg in men and <18 kg in women) and/or low gait speed (<0.8 m/s). Presarcopenia was diagnosed as either: (1) solely low muscle mass index; or (2) solely low handgrip strength and/or gait speed. Endpoints included perioperative biochemical indicators, postoperative complications, and the recovery of postoperative quality of life (QOL).

Results: In total, 212 patients were enrolled, including 55 (25.9%) and 60 (28.3%) patients diagnosed with sarcopenia and presarcopenia, respectively. The presarcopenic and normal patients showed a similar risk of postoperative complications and were combined. Despite similar baseline levels, sarcopenic patients (vs. non-sarcopenic) showed decreased prealbumin on postoperative day (POD) 1, decreased albumin on PODs 1, 3, and 5, and delayed recovery of lymphocyte counts (all P<0.05). The levels of C-reactive protein in sarcopenic patients was lower than in non-sarcopenic patients on POD 1 (P=0.010) but higher on POD 5 (P=0.001). Multivariate analyses demonstrated the independent predictive value of sarcopenia for overall complications (P<0.001), major complications (Clavien-Dindo grade ≥ III, P=0.001), and delayed hospital discharge (>12 days, P<0.001). Sarcopenia was demonstrated as a risk factor for deteriorated global QOL (P=0.001), physical (P=0.001) and role functions (P=0.006), and severe fatigue (P=0.004) at four weeks after surgery.

Conclusions: Sarcopenia was associated with poor metabolic stress and immune responses surrounding esophagectomy and was a potential target for reducing complications and promoting recovery of QOL.

Keywords: Esophageal cancer; Esophagectomy; Postoperative complications; Presarcopenia; Quality of life; Sarcopenia.