title: Preoperative sarcopenia is a predictor of postoperative pulmonary complications in esophageal cancer following esophagectomy: A retrospective cohort study.
abstract: The number of geriatric patients with esophageal cancer has been increasing. Geriatric syndromes such as sarcopenia might adversely affect postoperative recovery. The aim of this study was to evaluate the relationships between sarcopenia and postoperative complications, and the associations between sarcopenia and perioperative functional changes in patients with esophageal cancer following esophagectomy.
  
  
  
  Participants comprised 104 patients who underwent esophagectomy from July 2011 to April 2015. Preoperative sarcopenia was diagnosed by the presence of low muscle mass and low physical functions according to Asian Working Group for Sarcopenia criteria. Low physical function was defined by loss of grip strength and/or slow walking speed. Postoperative pulmonary, cardiac, infectious, and surgical complications were extracted. Perioperative functional changes were calculated (value at postoperative day 30-value before surgery). For statistical analyses, both uni- and multivariate logistic regression analyses were performed.
  
  
  
  Twenty-nine patients (27.9%) were diagnosed with sarcopenia. The incidence of postoperative pulmonary complications was significantly higher in the sarcopenia group (37.9%) than in the non-sarcopenia group (17.3%; P=0.04). There was no relationship between sarcopenia and other complications or perioperative functional changes. Multivariate analysis identified sarcopenia (odds ratio (OR), 3.13; 95% confidence interval (CI), 1.12-8.93) and high Brinkman index (OR, 3.46; 95% CI, 1.20-11.77) as independent risk factors for the development of pulmonary complications.
  
  
  
  The assessment of sarcopenia may be useful to predict the postoperative pulmonary complications following esophagectomy. On the other hand, sarcopenia does not predict cardiac, infectious, and surgical complications or perioperative function.
authors.affiliation: Division of Rehabilitation, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan; Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe 654-0142, Hyogo, Japan. Electronic address: d.makiura@eagle.kobe-u.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Makiura
authors.affiliation: Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe 654-0142, Hyogo, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Ono
authors.affiliation: Division of Rehabilitation, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Inoue
authors.affiliation: Division of Rehabilitation, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Kashiwa
authors.affiliation: Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Oshikiri
authors.affiliation: Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.affiliation: Division of Rehabilitation, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan; Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan.
authors.forename: Yoshitada
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Division of Rehabilitation, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan; Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe 654-0142, Hyogo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miura
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001823:Body Composition / Q000502:physiology; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications*; D016896:Treatment Outcome
keywords: Esophageal cancer; Esophagectomy; Functional status; Postoperative pulmonary complications; Rehabilitation; Sarcopenia