The Impact of Frailty and Sarcopenia in Patients Undergoing Esophagectomy for Esophageal Cancer
Abstract
Esophagectomy remains an integral part of cure for patients with esophageal cancer. The operation can be a source of significant morbidity and mortality, which highlights the importance of preoperative risk assessment and careful patient selection. Sarcopenia, defined as loss of muscle and function, and frailty are two measures of decreased physiologic reserve that have been associated with poor outcome in cancer patients. The first objective of this thesis was to summarize the existing literature on the available tools used to quantify frailty and sarcopenia. The second was to perform the first study using the National Surgical Quality Improvement Program (NSQIP) database to investigate the association between the 5-factor modified frailty index (mFI-5) and adverse outcomes in esophagectomy patients. The final objective was to measure sarcopenia and frailty in the same local esophagectomy patient cohort to investigate the association between these metrics of physiologic reserve and severe postoperative complications requiring intensive care. NSQIP data for esophagectomy patients from 2016-2018 were obtained and local patient data was collected from 2010-2016. Frailty was quantified using mFI-5 and sarcopenia status was attained by normalizing skeletal muscle area on preoperative computed tomography scans by sex and height. Based on the NSQIP database, mFI-5 showed associations with post-esophagectomy 30-day morbidity (i.e., Clavien-Dindo grade IV complications) but not mortality. In the local patient cohort, neither sarcopenia nor mFI-5 demonstrated significant associations with postoperative outcomes. In conclusion, sarcopenia and frailty are markers of physiologic vulnerability but may not correspond with statistically and clinically significant outcomes for esophagectomy patients.