SARCOPENIA IS ASSOCIATED WITH SEVERE POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER PATIENTS UNDERGOING ESOPHAGECTOMY: A HOSPITAL BASED PROSPECTIVE OBSERVATIONAL STUDY IN SUB-HIMALAYAN REGION

Dr. Ishan Barotra*, Dr. Ashish Katoch, Dr. Puneet Mahajan and Dr. Rashpal Singh Thakur

ABSTRACT

Background: Esophagectomy is the gold-standard treatment for locally advanced esophageal cancer but has high morbidity and mortality rates. Sarcopenia is a common comorbidity in cancer patients. The aim of this study was to investigate postoperative complications between sarcopenic and non-sarcopenic patients of resectable esophageal cancer undergoing esophagectomy. There is very limited data available from sub-Himalayan belt of northern India, hence the present study was planned to know the association of sarcopenia with postoperative complications in esophageal cancer patients undergoing esophagectomy. Methods: A hospital based prospective observational study was conducted in the Department of General Surgery of a tertiary care hospital in Shimla, Himachal Pradesh. All patients who reported to Department of Surgery during the study period of 1st September 2021 to 30th September 2022 with diagnosis of esophageal cancer were considered for the study. Results: Eighteen patients were included in the study. Patients had a mean age of 60.43± 14.16 years. Sarcopenia was detected in 8(44.44%) patients based on EWGSOP2 (The European Working Group on Sarcopenia in Older People 2) recommendations and 10 patients were non sarcopenic. The mean age was 65.37 years in the sarcopenic group (SG) and 55.5 years in the non-sarcopenic group(NSG). The mean SMI(Skeletal Muscle Index) was 42.23±7.10 cm²/m² and 47.14±6.24 cm²/m² in the SG and NSG, respectively. The mean body mass index (BMI) was lower in the sarcopenic group than in the nonsarcopenic group (19.11 ± 1.99 vs. 19.83± 2.13 kg/m2). Post operative complications based on Clavien Dindo classification were significantly higher in the sarcopenic group than in the non-sarcopenic group (sarcopenic, 66.66 %, vs. non-sarcopenic, 0 %; P = 0.03). Conclusions: Preoperative sarcopenia as defined by the EWGSOP2 recommendations is a risk factor for severe postoperative complications in esophageal cancer patients undergoing esophagectomy. Preoperative sarcopenia imposes a higher risk for overall complications and severe complications.

Keywords: Sarcopenia _ Postoperative complication _ Esophageal cancer _ Esophagectomy.