Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor
Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor
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DOI：
10.1186/s12957-020-01908-6
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发表时间：
2020-06-26
影响因子：
3.2
通讯作者：
Fujiwara, Toshiyoshi
中科院分区：
文献类型：
--
作者：
Maeda, Naoaki;Shirakawa, Yasuhiro;Fujiwara, Toshiyoshi
背景与其他胃肠道肿瘤相比，食管鳞状细胞癌（ESCC）患者的术后生存率仍然很低。我们假设，术后急性期骨骼肌丢失可能是高度侵袭性手术（如ESCC手术）后长期预后的新预测因素。方法回顾性调查。首先，验证ESCC术后急性期是否发生骨骼肌丢失。其次，研究了ESCC术后急性期骨骼肌丢失的术前和术中因素。然后，检查术后急性期骨骼肌损失是否影响长期预后。回顾性分析了2010年1月至2015年2月期间因ESCC接受根治性食管切除术的连续患者的病历; 72例病例符合本研究的条件。在术前和术后3天使用计算机断层扫描（CT）测量第三腰椎（L3）水平的总腰大肌质量指数（TPI）。采用Kaplan-Meier法和多因素Logistic回归模型估计远期预后。结果ESCC术后第3天急性期TPI较术前明显降低（P < 0.001）。术中失血量较少的病例和接受胸腔镜食管切除术的病例中TPI降低率显著低于接受开放性食管切除术的病例。TPI降低率重度组与TPI降低率轻度组的3年总生存率存在显著差异。结论术后急性期仍有骨骼肌缺损。此外，ESCC手术后急性期骨骼肌丢失与长期预后有关，这一点非常重要。
Background The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery. Methods The following items were retrospectively investigated. First, whether skeletal muscle loss occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in skeletal muscle loss in the postoperative acute phase of ESCC were investigated. Then, whether skeletal muscle loss in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC between January 2010 and February 2015 were retrospectively reviewed; 72 cases were eligible for this study. The total psoas major muscle mass index (TPI) at the level of the third lumbar vertebra (L3) was measured using computed tomography (CT) before surgery and 3 days after surgery. The long-term prognosis was estimated by the Kaplan-Meier method and the multivariate logistic regression model. Results There was already a significant reduction of TPI in the acute phase up to POD 3 after ESCC surgery in comparison with the preoperative baseline TPI (P < 0.001). The TPI reduction rate was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The 3-year overall survival rate was significantly different between the TPI reduction rate severe group and the TPI reduction rate mild group. Conclusion Skeletal muscle loss occurred even in the postoperative acute phase. Furthermore, it is very significant that skeletal muscle loss in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.