Impact of Preoperative Skeletal Muscle Mass and Physical Performance on Short-term and Long-term Postoperative Outcomes in Patients with Esophageal Cancer After Esophagectomy

Background: In patients with esophageal cancer who undergo esophagectomy, preoperative skeletal muscle mass loss has been reported to be associated with postoperative complications and poor prognosis. However, physical performance has not been fully investigated.

Methods: This study included 363 patients who underwent esophagectomy for thoracic esophageal cancer in 2013-2018. Preoperative skeletal muscle index (SMI) was measured with multifrequency bioelectrical impedance. Preoperative 6-minute walk distance (6MWD) was measured as an indicator of physical performance. We investigated the association between these factors and postoperative complications or long-term prognosis.

Results: Preoperative SMI was not associated with the occurrence of postoperative complications (33% vs 35%,  = .820), but low preoperative 6MWD was significantly associated with the occurrence of postoperative complications rather than high 6MWD (60% vs 30%,  < .001), especially pulmonary complications (23% vs 8%,  = .001). In the analysis of long-term prognosis, low preoperative SMI was associated with poor survival (Hazard ratio [HR] 1.77,  = .004). Low preoperative 6MWD was also associated with poor survival (HR 2.55,  < .001). Multivariate prognostic analysis showed that pT stage (HR 1.97,  = .001), pN stage (HR 3.27,  < .001), and 6MWD (HR 1.93,  = .008) were independent prognostic factors. In the low 6MWD group, the rate of death from other diseases was significantly higher than the other groups.

Conclusions: It is useful to evaluate 6MWD as a physical performance in addition to SMI when evaluating sarcopenia from the perspective of predicting postoperative complications and long-term prognosis in patients with esophageal cancer undergoing esophagectomy.