Abstract
Abstract Background Typical indicators of malnutrition in cancer patients include BMI, CONUT, PNI, and prealbumin, while SMI and PMI are often used as indicators of skeletal muscle mass loss (sarcopenia). Although these indicators have been reported to be associated with surgical outcomes, their combination may be useful in determining the effectiveness of perioperative management because these are closely related during the perioperative period. Methods A total of 132 esophageal cancer patients who underwent esophagectomy between January 2021 and May 2023 were included in this study. Preoperative BMI, CONUT, PNI, prealbumin, SMI (measured by BIA), and PMI (measured by CT imaging) were extracted from clinical record. We also selected BMI and SMI as a new indicator for combined malnutrition and loss of skeletal muscle. Then, we investigated the association between these indicator and postoperative complications (pneumonia, suture failure, total CD Grade ≥II, total CD ≥IIIa), and length of hospital stay. Results The mean age of patients was 67.3 years, 107 were male and 25 were female. Preoperative chemotherapy was administered to 58 patients. Although associations with each single index were found for postoperative pneumonia and low BMI, low SMI, and low PMI, there was no significant association with anastomotic leakage or overall complications. On the other hand, low BMI+SMI was strongly correlated with postoperative pneumonia, overall Grade≥II, and Grade≥IIIa complications. In postoperative hospital stay, low BMI, low PNI, and low SMI as single indicators showed a significant increase in hospital stay, while low BMI+SMI showed further statistically significant increase. Conclusion In patients who underwent esophagectomy, single index for malnutrition and low skeletal muscle mass may be predictors of postoperative complications respectively. However, because perioperative management is inseparable from nutritional therapy and exercise therapy, composite index of BMI and SMI may be better predictor of therapeutic efficacy of perioperative nutrition and exercise therapy.
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