The influence of perioperative decreasing total psoas area on prognosis of esophagieal cancer patients.

Abstract

38 Background: Depression of skeletal muscle mass (sarcopenia) has been linked to postoperative mortality in several carcinomas and various types of surgeries. Total psoas muscle area (TPA) has received attention as one of the indicators of systemic total skeletal muscle volume. The objective of this study is to determine the correlation between the patients who decreased TPA during pre-post operation and prognosis of esophageal cancer treated by surgical resection. Methods: We enrolled 40 esophageal cancer patients who underwent esophagectomy between April 2008 and May 2009. TPA was estimated by measuring the cross-sectional area of the psoas major muscle at the level of the third lumbar vertebra using an image-analysing software, identified on a preoperative CT scan, and a postoperative CT scan, which was taken on post-operative day 6. We divided the patients who decreased TPA between pre-post operation, into “decreasing group”, and the patients who preserved or increased TPA, into “non-decreasing group”. We investigated their backgrounds and prognosis. Results: Eighteen patients (45.0%) were classified as decreasing group, and 22(55.0%) patients were classified as non-decreasing group. Tumor locations, TMN Stage, or rates of neo-adjuvant chemotherapy, did not significantly differ between the two groups. Five-year overall survival rates (54.2% vs 85.7%, P = 0.046) were significantly lower in decreasing group in comparison with non-decreasing group. Recurrence-free survival rates (42.9% vs 85.7%, P = 0.012) were also significantly lower in decreasing group. The incidences of anastomotic leakage, or postoperative pneumonitis, did not differ between the two groups. Conclusions: The patients who decreased TPA during perioperative period associated with poor prognosis of esophageal cancer. The surgical operation for esophageal cancer is highly invasive, therefore active nutrition support and early rehabilitation during perioperative period might be indispensable.