Abstract

Background: While this relationship between skeletal muscle mass has been reported following esophagectomy, muscle quality measured by intramuscular adipose infiltration might better reflect physiological reserve. This study explored the potential correlation between preoperative quality of skeletal muscles and development of postoperative infectious complications and recovery process in esophageal cancer treated with esophagectomy. Methods: 274 patients undergoing a curative esophagectomy were analysed in a retrospective cohort. Skeletal muscle radiodensity was used to quantify skeletal muscle quality from the pre-operative Computed Tomography (CT) at the third lumbar vertebra. Patients were dichotomised at a sex-specific threshold into low and preserved muscle quality. The main end point was postoperative infectious complications within 30 days while the secondary end point was time to functional recovery. Multivariable logistic and Cox regression analyses were used to determine independent predictors. Results: 34.7% of the patients developed infectious complications. Low muscle quality was independently linked with infectious complications (Adjusted Odds Ratio (AOR) 2.63, 95% Confidence Interval (CI) 1.48-4.67), and with pneumonia alone (AOR 2.41, 95% CI 1.31-4.44), and was associated with delayed functional recovery (Adjusted Hazard Ratio (AHR) 0.58, 95% CI 0.43-0.78). Muscle quality was a superior discriminating factor than muscle mass. Conclusion: Preoperative muscle quality is an independent predictor of infectious complications and conferred additional prognostic information beyond muscle mass, supporting its use in the pre-operative risk assessment and prehabilitation strategy in patients who undergo esophagectomy.

Keywords: Skeletal muscle quality, Myosteatosis, Esophagectomy, Esophageal cancer, Infectious complications, Sarcopenia, Prehabilitation