Sarcopenia does not affect postoperative complication rates in oesophageal cancer surgery: a systematic review and meta-analysis

Abstract

Introduction: The high morbidity and mortality rates after oesophagectomy indicate the need for rigorous patient selection and preoperative risk assessment. Although muscle mass depletion has been proposed as a potential prognostic factor for postoperative complications and decreased survival in gastrointestinal cancer patients, available data are conflicting. The purpose of the present meta-analysis is to determine whether sarcopenia predicts postoperative outcomes in patients undergoing oesophagectomy.

Methods: The databases MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on the effect of sarcopenia on postoperative outcomes following oesophageal cancer surgery. Outcomes included surgical complications, anastomotic leakage, respiratory complications, cardiovascular complications, postoperative infections, major complications and overall complications. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented.

Findings: A total of eight studies involving 1488 patients diagnosed with oesophageal cancer and who underwent oesophagectomy were included in the meta-analysis. The presence of sarcopenia did not significantly increase the rate of surgical complications (odds ratio, OR, 0.86, 95% confidence interval, CI, 0.40-1.85), anastomotic leakage (OR 0.75, 95% CI 0.42-1.35), respiratory complications (OR 0.56, 95% CI 0.21-1.48), cardiovascular complications (OR 0.94, 95% CI 0.31-2.83), postoperative infection (OR 1.14, 95% CI 0.52-2.50), major complications (OR 0.81, 95% CI 0.23-2.82) or overall postoperative complications (OR 0.80, 95% 0.32-1.99).

Conclusion: Sarcopenia does not seem to affect postoperative complication rates of patients undergoing oesophagectomy for oesophageal cancer. Future research should focus on determining whether prognosis differs according to muscle mass in this patient population.

Keywords: Meta-analysis; Oesophageal cancer; Postoperative complications; Sarcopenia.

Figure 1

The PRISMA flow chart of study selection.

Figure 2

The methodological assessment of the included studies according to the Newcastle–Ottawa Scale.

Figure 3

Odds ratio according to surgical complications (anastomotic insufficiency, bleeding, chylothorax etc.). The overall effect was not statistically significant (P > 0.05). Vertical line: no difference point between two groups; squares: odds ratios; Diamonds: pooled odds ratio for all studies; horizontal lines, 95% confidence intervals (CI).

Figure 4

Odds ratio according to anastomotic leakage. The overall effect was not statistically significant (P > 0.05). Vertical line, no difference point between two groups; squares, odds ratios; diamonds, pooled odds ratio for all studies; horizontal lines, 95% confidence intervals (CI).

Figure 5

Odds ratio according to respiratory complications. The overall effect was not statistically significant (P > 0.05). Vertical line, no difference point between two groups; squares, odds ratios; diamonds, pooled odds ratio for all studies; horizontal lines, 95% confidence intervals (CI).

Figure 6

Odds ratio according to cardiovascular complications. The overall effect was not statistically significant (P > 0.05). Vertical line, no difference point between two groups; squares, odds ratios; diamonds, pooled odds ratio for all studies; horizontal lines, 95% confidence intervals (CI).

Figure 7

Odds ratio according to infection rates. The overall effect was not statistically significant (P > 0.05). Vertical line, no difference point between two groups; squares, odds ratios; diamonds, pooled odds ratio for all studies; horizontal lines, 95% confidence intervals (CI).

Figure 8

Odds ratio according to the Clavien–Dindo classification of complications. The overall effect was not statistically significant (P > 0.05). Vertical line, no difference point between two groups; squares, odds ratios; diamonds, pooled odds ratio for all studies; horizontal lines, 95% confidence intervals (CI).

Figure 9

Odds ratio according to overall postoperative complications. The overall effect was not statistically significant (P > 0.05). Vertical line, no difference point between two groups; squares, odds ratios; diamonds, pooled odds ratio for all studies; horizontal lines, 95% confidence intervals (CI).