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VISCERAL ADIPOSE TISSUE AREA ON CT IS ASSOCIATED WITH PULMONARY AND CARDIOVASCULAR COMPLICATIONS AFTER ESOPHAGECTOMY FOR CANCER
Ernest G. Chan
*1, Maria L. Madrariaga
1, Jules Lin
2, Darren Bryan
1, Brian A. Derstine
2, Pablo G. Sanchez
1, Stewart C. Wang
2, Mark Ferguson
11Surgery, University of Chicago, Chicago, IL; 2University of Michigan, Ann Arbor, MI
Background
Visceral adipose tissue (VAT) is associated with postoperative complications following surgery for cancers such as pancreatic and colorectal. We report results of VAT area and its association with acute adverse outcomes in patients undergoing esophagectomy for cancer.
Methods
We performed a retrospective analysis of patients who underwent esophagectomy for cancer at a single institution. Pre-surgical computed tomography DICOM files underwent body segmentation at L3 using a semi-automated method. Muscle and VAT components were measured as cross-sectional area. The relationship between VAT and muscle areas and postoperative outcomes (categorized as pulmonary, cardiovascular (CV), or other) were analyzed.
Results
We included 157 patients operated January 2000 to December 2013. Median age was 63.2 years with a median BMI of 28.4. The majority was male (128; 82%) and most had received neoadjuvant therapy (108; 69%). Median hospital stay was 9 days and 30-day mortality was 3.8%. 49 patients (31%) experienced at least one CV complication and 29 patients (18%) experienced at one or more pulmonary complications. VAT and low density muscle (indicating fatty infiltration) areas were related to BMI, normal density muscle area was not (Figure 1). Patients in the highest quartile of VAT area experienced an increased incidence of postoperative pulmonary (p=0.039) and CV (p=0.012) complications (Figure 2). We identified no relationship between muscle area and acute outcomes.
Conclusion
In patients undergoing esophagectomy for cancer, high visceral adipose tissue area on CT was predictive of an increased incidence of postoperative pulmonary and cardiovascular complications. This association may be related to the endocrine effects of adipocytes and their activation of a proinflammatory state that increases with expanding fat volume. Further exploration of this relationship is needed as is identification of modifiable pharmacologic targets to minimize morbidity following esophagectomy.
Viseral adipose tissue (VAT) and low density(LD) muscle (indicating fatty infiltration) areas were related to BMI, normal density(ND) muscle area was not.
Patients in the highest quartile of VAT area experienced an increased incidence of postoperative pulmonary (p=0.039) and CV (p=0.012) complications.
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