Myosteatosis predicts higher complications and reduced overall survival following radical oesophageal and gastric cancer surgery |
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| Affiliation: | 1. School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia;2. Department of Nutrition and Dietetics, Alfred Health, Melbourne, Australia;3. Department of Radiology, Alfred Health, Melbourne, Australia;4. Department of Medicine, Monash University, Melbourne, Australia;5. Hepaticopancreaticobiliary Surgery Unit, Alfred Health, Melbourne, Australia;6. Department of Surgery, Monash University, Melbourne, Australia;7. Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia;8. Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada;9. School of Allied Health, And Health Implementation Science and Technology, Health Research Institute, University of Limerick, Limerick, Ireland;1. Centre for Colorectal Disease, Saint Vincent''s University Hospital, Dublin 4, Ireland;2. Department of Surgery, School of Medicine and Medical Sciences, University College Dublin, Ireland;3. Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland;4. Hirslanden Group, Clinic Beau-Site, Schänzlihalde 11, 3000, Bern, Switzerland;5. Department of Digestive Surgery, University Hospital La Fe, University of Valencia, Valencia, Spain;1. Department of Gastroenterological Surgery, Section for Surgical Oncology, Norwegian Radium Hospital, Oslo University Hospital, Norway;2. Faculty of Medicine, University of Oslo, Norway;3. Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Norway;4. Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Norway;1. Department of Surgical Oncology, Homi Bhabha Cancer Hospital, Varanasi, India;2. Colorectal Division, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India |
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| Abstract: | IntroductionLow muscle attenuation, as governed by increased intramuscular fat infiltration (myosteatosis), may associate with adverse surgical outcomes. We aimed to determine whether myosteatosis is associated with an increased risk of postoperative complications and reduced long-term survival after oesophago-gastric (OG) cancer surgery.MethodsPatients who underwent radical OG cancer surgery with preoperative abdominal computed tomography (CT) imaging were included. Myosteatosis was evaluated using previously defined cut-points for low skeletal muscle attenuation measured by CT. Oncological, surgical, complications, and outcome data were obtained from a prospective database.ResultsOf 108 patients, 56% (n = 61) had myosteatosis. Patients with myosteatosis were older (69.1 ± 9.1 vs. 62.8 ± 9.8 years, p = 0.001) and had a similar body mass index (BMI) (23.4 ± 5.3 vs. 25.9 ± 6.7 kg/m2, p = 0.766) compared to patients with normal muscle attenuation. Patients with myosteatosis had a higher rate of anastomotic leaks (15% vs. 2%, p = 0.041). On multivariate analysis, myosteatosis was an independent predictor of overall (OR 3.03, 95% CI 1.31–6.99, p = 0.009) and severe complications (OR 4.33, 95% CI 1.26–14.9, p = 0.020). Patients with myosteatosis had reduced 5 year overall (54.1% vs. 83%, p = 0.004) and disease-free (55.2% vs. 87.2%, p = 0.007) survival.ConclusionMyosteatosis is associated with a significantly increased risk of overall and severe complications as well as substantially reduced long-term survival. Assessment of muscle attenuation provides analysis beyond standard anthropometrics and may form part of preoperative physiological staging tools used to improve surgical outcomes. |
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| Keywords: | Esophagectomy Gastrectomy Myosteatosis Complications Muscle attenuation ASA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" American Society of Anaesthesiologists BMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" body mass index CSA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" cross sectional area CT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" computed tomography HU" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" Hounsfield Units IMAT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" intramuscular adipose tissue LOS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" length of stay LOW" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" loss of weight OG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" oesophago-gastric SAT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" subcutaneous adipose tissue SM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," _" :" skeletal muscle SMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0150" }," $$" :[{" #name" :" text" ," _" :" skeletal muscle index VAT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0160" }," $$" :[{" #name" :" text" ," _" :" visceral adipose tissue |
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