Low muscularity increases the risk for post-operative pneumonia and delays recovery from complications after oesophago-gastric cancer resection

Journal article


Murnane, Lisa C., Forsyth, Adrienne K., Koukounaras, Jim, Pilgrim, Charles H. C., Shaw, Kalai, Brown, Wendy A., Mourtzakis, Marina, Tierney, Audrey C. and Burton, Paul R.. (2021). Low muscularity increases the risk for post-operative pneumonia and delays recovery from complications after oesophago-gastric cancer resection. ANZ Journal of Surgery. 91(12), pp. 2683-2689. https://doi.org/10.1111/ans.17203
AuthorsMurnane, Lisa C., Forsyth, Adrienne K., Koukounaras, Jim, Pilgrim, Charles H. C., Shaw, Kalai, Brown, Wendy A., Mourtzakis, Marina, Tierney, Audrey C. and Burton, Paul R.
Abstract

Background
Low muscularity is associated with adverse surgical outcomes. We aimed to determine whether low muscularity is associated with an increased risk of post-operative complications and reduced long-term survival after oesophago-gastric cancer surgery.

Methods
Patients who underwent radical oesophago-gastric cancer surgery with preoperative abdominal computed tomography (CT) imaging were included. Low skeletal muscle index (SMI), measured by CT, was determined using pre-defined cut-points. Oncological, surgical, complications and outcome data were obtained from a prospective database.

Results
Of 108 patients, 61% (n = 66) had low SMI preoperatively. Patients with low SMI had a higher rate of post-operative pneumonia (30 vs. 7% normal muscularity, P = 0.004). Median length of stay (LOS) was higher in patients with low SMI if they had any complication (19.5 vs. 14 days, P = 0.026) or pneumonia (21 vs. 13 days, P = 0.018). On multivariate analysis, low SMI (OR 3.85, CI 1.10–13.4, P = 0.025), preoperative weight loss (OR 1.13, CI 1.01–1.25, P = 0.027), and smoking (OR 5.08, CI 1.24–20.9, P = 0.024) were independent predictors of having a severe complication. There was no difference in 5-year overall (62% vs. 69%, P = 0.241) and disease-free (11% vs. 21.4%, P = 0.110) survival between low SMI and normal muscle mass groups.

Conclusion
Low SMI is associated with a significantly increased risk of pneumonia and increased LOS for patients with complications. Assessment of muscle mass may require additional muscle quality, strength, and physical performance measures to enhance preoperative risk assessment.

Keywordscomplications; gastrectomy; muscle mass; oesophagectomy; pneumonia
Year2021
JournalANZ Journal of Surgery
Journal citation91 (12), pp. 2683-2689
PublisherJohn Wiley & Sons, Inc.
ISSN1445-1433
Digital Object Identifier (DOI)https://doi.org/10.1111/ans.17203
Page range2683-2689
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online27 Sep 2021
Publication process dates
Accepted30 Aug 2021
Deposited21 Nov 2022
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