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Meta-Analysis
. 2023 Aug 17;23(1):240.
doi: 10.1186/s12893-023-02149-6.

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

Amanda Park  1   2 , Marina Feliciano Orlandini  1   2 , Daniel José Szor  1 , Ulysses Ribeiro Junior  1 , Francisco Tustumi  3
Affiliations
Meta-Analysis

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

Amanda Park et al. BMC Surg. .

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.

Keywords: Esophageal neoplasms; Esophagectomy; Meta-analysis; Sarcopenia; Systematic review.

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Conflict of interest statement

The authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA 2020 Flowchart
Fig. 2
Fig. 2
Postoperative mortality
Fig. 3
Fig. 3
Postoperative complications. (a) Overall complications; (b) Severe complications (Clavien-Dindo > IIIa)
Fig. 4
Fig. 4
Postoperative complications. (a) Anastomotic leak; (b) Pneumonia
Fig. 5
Fig. 5
Length of hospital stay
Fig. 6
Fig. 6
Overall survival (3-year follow-up)
See this image and copyright information in PMC

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