THE IMPACT OF PREOPERATIVE SARCOPENIA ON ESOPHAGECTOMY FOR CANCER: SYSTEMATIC REVIEW AND META-ANALYSIS
Amanda Park2, Marina Feliciano Orlandini2, Daniel J. Szor1,3, Francisco Tustumi*1,3, Ulysses Ribeiro1
1Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil; 2Centro Universitario Lusiada, Santos, SP, Brazil; 3Sociedade Beneficente Israelita Brasileira Albert Einstein, Sao Paulo, São Paulo, Brazil
Introduction: Esophagectomy is the gold-standard treatment for locally advanced esophageal cancer but has high morbimortality rates. Sarcopenia is a common comorbidity in esophageal cancer patients. The association of esophagectomy and preoperative sarcopenia may relate to poor prognosis. However, the exact burden of sarcopenia in esophagectomy remains unclear. Therefore, this systematic review and meta-analysis aimed to establish the impact of sarcopenia on postoperative outcomes of esophagectomy for cancer.
Methods: An electronic search was conducted by two reviewers 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. Forest plots were used for synthesis and expressed by the risk difference (RD) or mean difference (MD). Statistical heterogeneity was evaluated with I2. Random effect models were applied. All studies underwent the risk of bias assessment by the ROBINS-I tool and quality of evidence analysis by GRADE. This study was written following PRISMA statement recommendations.
Results: 38 studies were included in the meta-analysis. Patients with preoperative sarcopenia had a higher risk for postoperative complications (RD: 0.08; 95% CI: 0.02 to 0.14; I2: 67.7%), severe postoperative complications (RD: 0.11; 95% CI: 0.04 to 0.19; I2: 68.9%), pneumonia (RD: 0.13; 95% CI: 0.09 to 0.18; I2: 63.7%), and longer hospital stay (MD: 3.54 days; 95% CI: 0.41 to 6.66 days; I2: 94.8%) than patients with no preoperative sarcopenia. No significant difference was found for postoperative mortality (RD: 0.01; 95% CI: -0.03 to 0.05; I2: 93.3%) and anastomotic leak (RD: 0.01; 95% CI: -0.01 to 0.02; I2: 0). The 3-year overall survival was lower in patients with sarcopenia (RD: -0.16; 95% CI: -0.23 to -0.10; I2: 70.3%; Figure 1). The major risk of bias concern was related to the risk of selection, and certainty was very low to moderate.
Conclusion: Preoperative sarcopenia impacts postoperative early and long-term outcomes in esophagogastric resection for cancer.
Registration number: CRD42021270332.
Figure 1. The 3-year overall survival. Patients with sarcopenia had a lower probability of survival at a 3-year follow-up than those without.
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