TY - JOUR
T1 - Low muscularity increases the risk for post-operative pneumonia and delays recovery from complications after oesophago-gastric cancer resection
AU - Murnane, Lisa C.
AU - Forsyth, Adrienne K.
AU - Koukounaras, Jim
AU - Pilgrim, Charles H.C.
AU - Shaw, Kalai
AU - Brown, Wendy A.
AU - Mourtzakis, Marina
AU - Tierney, Audrey C.
AU - Burton, Paul R.
N1 - Publisher Copyright:
© 2021 Royal Australasian College of Surgeons.
PY - 2021/12
Y1 - 2021/12
N2 - Background: Low muscularity is associated with adverse surgical outcomes. We aimed to determine whether low muscularity is associated with an increased risk of post-operative complications and reduced long-term survival after oesophago-gastric cancer surgery. Methods: Patients who underwent radical oesophago-gastric cancer surgery with preoperative abdominal computed tomography (CT) imaging were included. Low skeletal muscle index (SMI), measured by CT, was determined using pre-defined cut-points. Oncological, surgical, complications and outcome data were obtained from a prospective database. Results: Of 108 patients, 61% (n = 66) had low SMI preoperatively. Patients with low SMI had a higher rate of post-operative pneumonia (30 vs. 7% normal muscularity, P = 0.004). Median length of stay (LOS) was higher in patients with low SMI if they had any complication (19.5 vs. 14 days, P = 0.026) or pneumonia (21 vs. 13 days, P = 0.018). On multivariate analysis, low SMI (OR 3.85, CI 1.10–13.4, P = 0.025), preoperative weight loss (OR 1.13, CI 1.01–1.25, P = 0.027), and smoking (OR 5.08, CI 1.24–20.9, P = 0.024) were independent predictors of having a severe complication. There was no difference in 5-year overall (62% vs. 69%, P = 0.241) and disease-free (11% vs. 21.4%, P = 0.110) survival between low SMI and normal muscle mass groups. Conclusion: Low SMI is associated with a significantly increased risk of pneumonia and increased LOS for patients with complications. Assessment of muscle mass may require additional muscle quality, strength, and physical performance measures to enhance preoperative risk assessment.
AB - Background: Low muscularity is associated with adverse surgical outcomes. We aimed to determine whether low muscularity is associated with an increased risk of post-operative complications and reduced long-term survival after oesophago-gastric cancer surgery. Methods: Patients who underwent radical oesophago-gastric cancer surgery with preoperative abdominal computed tomography (CT) imaging were included. Low skeletal muscle index (SMI), measured by CT, was determined using pre-defined cut-points. Oncological, surgical, complications and outcome data were obtained from a prospective database. Results: Of 108 patients, 61% (n = 66) had low SMI preoperatively. Patients with low SMI had a higher rate of post-operative pneumonia (30 vs. 7% normal muscularity, P = 0.004). Median length of stay (LOS) was higher in patients with low SMI if they had any complication (19.5 vs. 14 days, P = 0.026) or pneumonia (21 vs. 13 days, P = 0.018). On multivariate analysis, low SMI (OR 3.85, CI 1.10–13.4, P = 0.025), preoperative weight loss (OR 1.13, CI 1.01–1.25, P = 0.027), and smoking (OR 5.08, CI 1.24–20.9, P = 0.024) were independent predictors of having a severe complication. There was no difference in 5-year overall (62% vs. 69%, P = 0.241) and disease-free (11% vs. 21.4%, P = 0.110) survival between low SMI and normal muscle mass groups. Conclusion: Low SMI is associated with a significantly increased risk of pneumonia and increased LOS for patients with complications. Assessment of muscle mass may require additional muscle quality, strength, and physical performance measures to enhance preoperative risk assessment.
KW - complications
KW - gastrectomy
KW - muscle mass
KW - oesophagectomy
KW - pneumonia
UR - http://www.scopus.com/inward/record.url?scp=85115739362&partnerID=8YFLogxK
U2 - 10.1111/ans.17203
DO - 10.1111/ans.17203
M3 - Article
C2 - 34580983
AN - SCOPUS:85115739362
SN - 1445-1433
VL - 91
SP - 2683
EP - 2689
JO - ANZ Journal of Surgery
JF - ANZ Journal of Surgery
IS - 12
ER -