Mehmet Onur Gul; Cagla Bali
Volume 24, Issue 6 , 2022
Abstract
Background: Sarcopenia may adversely affect treatment responses and oncological outcomes in cancer patients. However, the importance of pretreatment nutritional assessment as an indicator of treatment response and outcome in patients with gastric cancer undergoing neoadjuvant chemotherapy remains unclear.
Objectives: ...
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Background: Sarcopenia may adversely affect treatment responses and oncological outcomes in cancer patients. However, the importance of pretreatment nutritional assessment as an indicator of treatment response and outcome in patients with gastric cancer undergoing neoadjuvant chemotherapy remains unclear.
Objectives: This study aims to investigate the clinical impact of sarcopenia on gastric cancer and to determine the effect of neoadjuvant chemotherapy (NC) on sarcopenia, as well as body mass index (BMI), psoas muscle index (PMI), and prognostic nutrition index (PNI).
Methods: A retrospective review was performed on patients with gastric adenocarcinoma who were operated on after the NC therapy between January 2016 and December 2019. Weight, BMI-, PMI-, and PNI-dependent variables were compared before and after the NC treatment. Sarcopenia was defined according to PMI at the level of the third lumbar vertebra based on computed tomography.
Results: Forty-five patients (64.4% women) with a mean age of 56.9±11.2 years were included in the study. After the NC treatment, the mean BMI of the cohort decreased from 26.1±4.3 kg/m2 to 25.1±4.2 kg/m2, the mean PMI decreased from 5.69±1.39 cm2/m2 to 5.16±1.50 cm2/m2, and the mean PNI decreased from 46.6±6.5 to 40.0±7.0 (All, P<0.001). The NC treatment increased the frequency of sarcopenia from 48.9% to 64.5% (P<0.001).
According to the Clavien-Dindo (CD) scoring, grade >3 CD complications were more common in the sarcopenic group (27.2%), compared to the non-sarcopenic group (8.7%) (P=0.049). The one-year and three-years overall survival rates were lower in the sarcopenic group (91.7% and 38.2%, respectively), compared to the non-sarcopenic group (93.8% and 45.8%, respectively). However, it was not statistically significant (P=0.509).
Conclusion: Sarcopenia is associated with severe postoperative complications in gastric cancer. In addition, the NC treatment reduces PMI, BMI, as well as PNI, and increases sarcopenia frequency. Therefore, patients should be examined in terms of sarcopenia at the time of diagnosis.
Mevlut Harun A?ca; U?ur Topal; Cem Kaan Parsak; ismail Cem Eray; Mehmet Onur Gul; ?shak Ayd?n
Volume 23, Issue 10 , 2021
Abstract
Background: Esophageal cancer is the eighth most common cancer and the sixth most common cause of death from cancer. Esophagectomy is still the essential treatment for esophageal cancer despite its high morbidity rate. The prediction of complications that are likely to appear after surgery can be the ...
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Background: Esophageal cancer is the eighth most common cancer and the sixth most common cause of death from cancer. Esophagectomy is still the essential treatment for esophageal cancer despite its high morbidity rate. The prediction of complications that are likely to appear after surgery can be the most critical factor in reducing morbidity.
Objectives: The present study aimed to examine the postoperative complications and causes of mortality in patients undergoing esophagectomy for esophageal cancer.
Methods: Data from 34 patients with esophageal adenocarcinoma or squamous cell carcinoma undergoing esophagectomy in the general surgery clinic of Çukurova University Medical School Hospital were collected and analyzed retrospectively between January 1, 2011, and January 1, 2020. Postoperative complications were identified according to the Clavien-Dindo classification (CD). "The patients were assigned into two groups (Group 1 and Group 2). Group 1 and Group 2 included patients with CD grade <3 and CD grade >3, respectively."
Results: The mean±SD age of patients (n=34) undergoing resection for esophageal cancer was obtained at 56.38±11.00 years. The ratio of female to male patients was equal. The most common accompanying disease was diabetes mellitus. The number of patients with the American Society of Anesthesiologists score 3 was higher in Group 2 (P=0.034). The tumor was most frequently located in the lower thoracic esophagus of patients in Group 1 and Group 2, and the rate of cervical anastomosis was higher in Group 2. The rate of manual anastomosis was higher in both groups. Respiratory complications were the most frequent complication in both groups; however, a higher rate of respiratory complications was observed in Group 2 (P=0.038). The postoperative 30-days mortality and the reoperation rate were higher in Group 2.
Conclusion: Radical surgery for esophageal cancer results in a high rate of complications and death due to the location of the tumor and diagnosis at the advanced stage. Complications and mortality may result from patient-related factors and the surgical technique. The diagnosis and treatment of the correctable causes before surgery can enhance the chance of survival and the quality of life in patients.
