238. ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS WITH SARCOPENIA BEFORE OR AFTER NEOADJUVANT CHEMOTHERAPY ARE MORE LIKELY TO HAVE LONGER POST-OPERATIVE INPATIENT STAYS

Abstract

Abstract Background Sarcopenia is defined as a loss of skeletal muscle mass and function. It is prevalent amongst patients with esophagogastric adenocarcinoma (EGA) and associated with adverse treatment outcomes. The majority of this evidence comes from populations with squamous cell carcinoma or where neoadjuvant chemoradiotherapy was used. Protracted inpatient stays are directly associated with adverse events such as healthcare-associated infections and patient deconditioning and increase the economic burden on healthcare institutions. Methods Patients diagnosed with EGA between January 2017 and December 2021 and undergoing neoadjuvant chemotherapy (NAC) followed by esophagectomy from a single tertiary center in the UK had their pre- and post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4 cm2 for men and 38.5 cm2 for women). Wilcoxon signed-rank test for non-parametric data was used to determine significance. Results 191 patients were included in the analysis. The number of patients with sarcopenia increased from 96 to 123 following NAC. Sarcopenia before (p = 0.047) or after (p = 0.007) NAC was significantly associated with longer inpatient stays post-operatively. The median stay for patients with sarcopenia before or after NAC was 12 days compared to 9 for those without sarcopenia before or after NAC. Conclusion Radiological sarcopenia is highly prevalent in this cohort of patients and increases following NAC. This study demonstrates that sarcopenia before or after NAC in patients with EGA undergoing esophagectomy are likely to have longer inpatient stays following surgery. Peri-operative treatment to treat and reduce the incidence of sarcopenia should be trialed with the aim of improving post-operative outcomes in this cohort.