The impact of sarcopenia on esophagectomy for cancer: a systematic review and meta-analysis

• Published in: BMC surgery Vol. 23; no. 1; pp. 1 - 240
• Main Authors: Park, Amanda, Orlandini, Marina Feliciano, Szor, Daniel José, Junior, Ulysses Ribeiro, Tustumi, Francisco
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 17.08.2023; BioMed Central; BMC
• Subjects: Analysis; Cancer; Care and treatment; Case reports; Clinical trials; Comorbidity; Complications; Criteria; Database searching; Esophageal cancer; Esophageal neoplasms; Esophagectomy; Gastrointestinal surgery; Internet/Web search services; Length of stay; Malnutrition; Meta-analysis; Mortality; Musculoskeletal system; Oncology, Experimental; Online searching; Patients; Postoperative; Postoperative period; Sarcopenia; Search strategies; Surgical anastomosis; Survival; Systematic review; Tomography
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-023-02149-6

Abstract Background Esophagectomy is the gold-standard treatment for locally advanced esophageal cancer but has high morbimortality rates. Sarcopenia is a common comorbidity in cancer patients. The exact burden of sarcopenia in esophagectomy outcomes remains unclear. Therefore, this systematic review and meta-analysis were performed to establish the impact of sarcopenia on postoperative outcomes of esophagectomy for cancer. Methods We performed a systematic review and meta-analysis comparing sarcopenic with non-sarcopenic patients before esophagectomy for cancer (Registration number: CRD42021270332). An electronic search was conducted on Embase, PubMed, Cochrane, and LILACS, alongside a manual search of the references. The inclusion criteria were cohorts, case series, and clinical trials; adult patients; studies evaluating patients with sarcopenia undergoing esophagectomy or gastroesophagectomy for cancer; and studies that analyze relevant outcomes. The exclusion criteria were letters, editorials, congress abstracts, case reports, reviews, cross-sectional studies, patients undergoing surgery for benign conditions, and animal studies. The meta-analysis was synthesized with forest plots. Results The meta-analysis included 40 studies. Sarcopenia was significantly associated with increased postoperative complications (RD: 0.08; 95% CI: 0.02 to 0.14), severe complications (RD: 0.11; 95% CI: 0.04 to 0.19), and pneumonia (RD: 0.13; 95% CI: 0.09 to 0.18). Patients with sarcopenia had a lower probability of survival at a 3-year follow-up (RD: -0.16; 95% CI: -0.23 to -0.10). Conclusion Preoperative sarcopenia imposes a higher risk for overall complications and severe complications. Besides, patients with sarcopenia had a lower chance of long-term survival.