The purpose of this study was to examine the association between PPCs and preoperative respiratory sarcopenia in patients undergoing esophagectomy. The purpose of this study was to examine the association between PPCs and preoperative respiratory sarcopenia in patients undergoing esophagectomy.
This single-center, retrospective, observational study included esophageal cancer patients who underwent esophagectomy between June 2021 and February 2024. Respiratory sarcopenia was diagnosed when both inspiratory muscle weakness and low respiratory muscle mass were present. Inspiratory muscle weakness was defined as a maximum inspiratory pressure below the lower limit of normal (60 cmH20 in males and 40 cmH20 in females). Respiratory muscle mass, assessed as diaphragm thickness (DT), was measured by B-mode ultrasonography at end-expiration with the patient in the supine position using a 10–5 MHz linear transducer.
Low respiratory muscle mass was defined as DT below the lower limit of normal (1.7 mm in males and 1.3 mm in females). The association between PPCs and respiratory sarcopenia was examined using a Bayesian generalized linear model with the Markov Chain Monte Carlo (MCMC) method, we calculated the mean odds ratio (OR) and the probability that OR is less than one. Covariates were age, gender, clinical stage, smoking, comorbidities, and nutritional status, adjusted for inverse probability weighting by propensity score.
78 patients were included, 16 (22%) in the respiratory sarcopenia (age: 71.9 ± 8.7 years, 14 males, BMI: 19.5 ± 3.1 kg/m2) and 62 (78%) in the non - respiratory sarcopenia (age: 65.8 ± 8.5 years, 50 males, BMI: 21.3 ± 2.8 kg/m2). Preoperative respiratory sarcopenia was associated with PPCs (OR: 4.23; 95% credible interval [95% CrI]: 1.16, 11.19) in the unweighted model, with a probability of 98.6% that OR exceeds 1. A similar association was observed in the weighted model adjusted for preoperative contributing factors (mean OR: 2.90; 94% CrI: 0.77, 7.70), with a 93.6% probability that OR exceeds 1.
It was suggested that esophagectomy patients with respiratory sarcopenia may be at higher risk for PPCs.It was suggested that esophagectomy patients with respiratory sarcopenia may be at higher risk for PPCs.
This study highlights the importance of early identification and management of respiratory sarcopenia in patients undergoing esophagectomy. Given the association between respiratory sarcopenia and an increased risk of PPCs, preoperative screening for inspiratory muscle weakness and low respiratory muscle mass could help stratify high-risk patients. Further investigation is needed to determine whether interventions to improve respiratory muscle function and respiratory muscle mass before surgery will reduce the incidence of PPCs.
esophageal cancer
ultrasonography
