Oral Presentation AANZGOSA-SUGSS ASM 2024

Developing sarcopenic visceral obesity during neoadjuvant treatment worsens postoperative outcomes following oesophagectomy (112658)

Emma J Putrus 1 , Claire O Nixon 1 , Matthew P Wallen 2 , Ahmed WH Barazanchi 3 , Shelley E Keating 4 , Alice S Day 5 6 , Koli R Ali 7 , Emmanuel S Gnanamanickam 8 , Harsh A Kanhere 9
  1. Nutrition and Dietetics, General Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. Exercise Science and Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
  3. Oesophagogastric, Bariatric and General Surgery, Wellington Hospital, Wellington, New Zealand
  4. School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
  5. Department Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
  6. Basil Hetzel Institute, Adelaide, South Australia, Australia
  7. Upper Gastrointestinal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  8. Adelaide Centre for Clinical Epidemiology, University of Adelaide and Central Adelaide Local Health Network, Adelaide, South Australia, Australia
  9. Upper Gastrointestinal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia

ABSTRACT 

Background:  Alterations in skeletal muscle and visceral adipose mass may occur during neoadjuvant treatment (NAT) for oesophageal cancer. We aimed to explore these changes and sarcopenic visceral obesity (SVO) as a novel composite metric on postoperative outcomes. 

Methods: Retrospective cohort study of adults who underwent oesophagectomy following NAT from 2018-2023. Skeletal muscle index (SMI) and visceral fat area (VFA) were measured at L3 vertebral level on pre- and post-NAT Computer Tomography scans using SliceOmatic™ software. SVO was defined as concurrent sarcopenia (SMI Men: Body mass index (BMI) <24.9= <43cm2/m2, BMI>25= <53 cm2/m2, Women= <41cm2/m2) and visceral obesity (VFA Men= >163.8cm2, Women= >80.1cm2). Baseline characteristics, anthropometric measurements and surgical outcomes were collected. Complications explored were anastomotic leaks, chyle leaks and respiratory complications.  

Results: Of 74 patients (64.7±8.7 years, 77% male), 66.2% were distal oesophageal adenocarcinomas. Primary treatment was neoadjuvant chemoradiotherapy (84.2%) and subsequent minimally invasive/hybrid oesophagectomy (92%). Significant reductions were observed in SMI (4.65cm2/m2, 95%CI,3.8-5.5; P<0.001) and VFA (19.33cm2, 95%CI,11.3-27.4; P<0.001) following NAT. Patients who experienced respiratory complications lost significantly less VFA (18.4%, 95%CI,1.3-35.5; P=0.035) during NAT. De-novo sarcopenia in isolation did not increase postoperative complications. 17 of 74 (23%) patients developed de-novo SVO post-NAT and higher odds of respiratory complications (OR 3.97 95%CI,1.1-14.3, P=0.035).  

Conclusion: Significant reductions in SMI and VFA occurred during NAT. Those who experienced respiratory complications had significantly lower reduction in VFA. Patients who developed de-novo SVO had ~4-fold greater likelihood of postoperative respiratory complications. Targeted prehabilitation, including respiratory, nutritional, and exercise interventions, may benefit at-risk patients.