Effect of sarcopenia on the perioperative clinical outcomes of esophageal squamous cell carcinoma
-
摘要:目的
探讨肌少症对食管鳞癌围手术期临床结局的影响。
方法采用回顾性病例对照研究方法。收集2020年1月至2021年12月南京医科大学附属淮安第一人民医院收治的1 148例食管鳞癌患者的临床病理资料;男789例,女359例;年龄为(67±7)岁。所有患者行胸腹腔镜联合食管癌根治术。观察指标:(1)食管鳞癌患者并发肌少症情况。(2)食管鳞癌并发肌少症患者与食管鳞癌非肌少症患者的一般资料比较。(3)食管鳞癌并发肌少症患者与食管鳞癌非肌少症患者的临床结局比较。(4)食管鳞癌患者并发肌少症的影响因素分析。正态分布的计量资料以x±s表示,组间比较采用t检验;计数资料以绝对数表示,组间比较采用χ2检验;等级资料采用Mann‑Whitney U检验。单因素分析采用Logistic回归分析,多因素分析采用Logistic逐步回归向后模型。
结果(1)食管鳞癌患者并发肌少症情况。1 148例食管鳞癌患者中,469例并发肌少症,679例非肌少症,肌少症发生率为40.854%(469/1 148)。469例并发肌少症患者中,男313例,女156例;年龄<65岁、≥65岁且<70岁、≥70岁且<75岁、≥75岁分别为125、145、106、93例。(2)食管鳞癌并发肌少症患者与食管鳞癌非肌少症患者的一般资料比较。469例食管鳞癌并发肌少症患者的年龄,肿瘤长径,体质量指数,T分期(T1期、T2期、T3期),术前白蛋白,术前血清前白蛋白,腰大肌指数,腰大肌密度分别为(68±7)岁,(3.3±1.5)cm,(22.4±2.9)kg/m2,100、105、264例、(43±4)g/L,(193±38)mg/dL,(3.9±0.8)cm2/m2,(48±8)HU;679例食管鳞癌非肌少症患者上述指标分别为(66±7)岁,(3.2±1.4)cm,(23.8±3.0)kg/m2,173、170、336例,(44±4)g/L,(206±37)mg/dL,(6.0±2.2)cm2/m2,(50±7)HU,两者上述指标比较,差异均有统计学意义(t=5.74、2.11、7.57,Z=-2.93,t=2.25、5.52、20.36、4.18,P<0.05)。(3)食管鳞癌并发肌少症患者与食管鳞癌非肌少症患者的临床结局比较。469例食管鳞癌并发肌少症患者的术后住院时间、术后住院时间>30 d、肺炎、急性呼吸衰竭、吻合口瘘、心律失常例数分别为(17±9)d 、32例、158例、39例、33例、103例,679例食管鳞癌非肌少症患者上述指标分别为(15±6)d、15例、102例、18例、19例、85例,两者上述指标比较,差异均有统计学意义(t=4.89,χ²=15.04、55.17、18.86、11.52、18.06,P<0.05)。(4)食管鳞癌患者并发肌少症的影响因素分析。多因素分析结果显示:年龄≥65岁是食管鳞癌患者并发肌少症的独立危险因素(优势比=1.64,95%可信区间为1.26~2.14,P<0.05);术前血清前白蛋白≥200 mg/dL、腰大肌密度≥48 HU和体质量指数>24 kg/m2是食管鳞癌患者并发肌少症的独立保护因素(优势比=0.64、0.72、0.53,95%可信区间为0.50~0.82、0.56~0.92、0.41~0.69,P<0.05)。
结论年龄≥65岁是食管鳞癌患者并发肌少症的独立危险因素,而术前血清前白蛋白≥200 mg/dL、腰大肌密度≥48 HU和体质量指数>24 kg/m2是食管鳞癌患者并发肌少症的独立保护因素。与食管鳞癌非肌少症患者比较,食管鳞癌并发肌少症患者术后更易发生肺炎、急性呼吸衰竭、吻合口瘘、心律失常等并发症,且术后住院时间更长。
Abstract:ObjectiveTo investigate the effect of sarcopenia on the perioperative clinical outcomes of esophageal squamous cell carcinoma (ESCC).
MethodsThe retrospective case‑control study was conducted. The clinicopathological data of 1 148 ESCC patients who were admitted to the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University from January 2020 to December 2021 were collected. There were 789 males and 359 females, aged (67±7)years. All patients under-went thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer. Observation indicators: (1) incidence of sarcopenia in patients with ESCC; (2) comparison of general data between ESCC patients complicated with sarcopenia and those without sarcopenia; (3) comparison of clinical outcomes between ESCC patients complicated with sarcopenia and those without sarcopenia; (4) analysis of influencing factors for sarcopenia in ESCC patients. Measurement data of normal distri-bution were represented by Mean±SD, and comparison between groups was conducted using the t test. Count data were represented as absolute numbers, and comparison between groups was conducted using the chi‑square test. Ordinal data was analyzed using the Mann‑Whitney U test. Logistic regression analysis was used to conduct univariate analysis. Logistic backward stepwise regression model was used to conduct multivariate analysis.
Results(1) Incidence of sarcopenia in patients with ESCC. Among 1 148 ESCC patients, 469 cases were complicated with sarcopenia, 679 were without sarcopenia. The incidence of sarcopenia was 40.854%(469/1 148). Among the 469 patients with sarcopenia, there were 313 males and 156 females. There were 125 cases <65 years old, 145 cases ≥65 years old but <70 years old, 106 cases ≥70 years old but<75 years old, 93 cases ≥75 years old, respectively. (2) Comparison of general data between patients with ESCC complicated with sarco-penia and those without sarcopenia. The age, tumor diameter, body mass index, cases in stage T1, T2, T3, preoperative albumin, preoperative serum prealbumin, psoas muscle index, psoas muscle density were (68±7)years, (3.3±1.5)cm, (22.4±2.9)kg/m2, 100, 105, 264, (43±4)g/L, (193±38)mg/dL, (3.9±0.8)cm2/m2, (48±8)HU of 469 ESCC patients complicated with sarcopenia, versus (66±7)years, (3.2±1.4)cm, (23.8±3.0)kg/m2, 173, 170, 336, (44±4)g/L, (206±37)mg/dL, (6.0±2.2)cm2/m2, (50±7)HU of 679 ESCC patients without sarcopenia, showing significant differences between the two groups (t=5.74, 2.11, 7.57, Z=-2.93, t=2.25, 5.52,20.36, 4.18, P<0.05). (3) Comparison of clinical outcomes between patients with ESCC complicated with sarcopenia and those without sarcopenia. The duration of postoperative hospital stay, cases with postoperative hospital stay>30 days, pneumonia, acute respiratory failure, anastomotic fistula, and abnormal heart rhythm were (17±9)days, 32, 158, 39, 33, and 103 of 469 ESCC patients complicated with sarcopenia, respectively, versus (15±6)days, 15, 102, 18, 19, and 85 of 679 ESCC patients without sarcopenia, showing significant differences between the two groups (t=4.89, χ²=15.04, 55.17, 18.86, 11.52, 18.06, P<0.05). (4) Analysis of influencing factors for sarcopenia in ESCC patients. Results of multivariate analysis showed that age ≥65 years was an independent risk factor for sarcopenia in ESCC patients (odds ratio=1.64, 95% confidence interval as 1.26-2.14, P<0.05). Preoperative serum prealbumin ≥200 mg/dL, psoas muscle density ≥48 HU and body mass index >24 kg/m2 were independent protective factors for sarcopenia in ESCC patients (odds ratio=0.64, 0.72, 0.53, 95% confidence interval as 0.50-0.82, 0.56-0.92, 0.41-0.69, P<0.05).
ConclusionsAge ≥65 years is an independent risk factor for sarcopenia in ESCC patients. Preoperative serum prealbumin ≥200 mg/dL, psoas muscle density ≥48 HU and body mass index >24 kg/m2 are independent protective factors for sarcopenia in ESCC patients. Compared with patients without sarcopenia, ESCC patients with sarcopenia are more prone to postoperative compli-cations such as pneumonia, acute respiratory failure, anastomotic fistula, and arrhythmia, and have a longer postoperative hospital stay.
-
Keywords:
- Esophageal neoplasms /
- Sarcopenia /
- Psoas muscle index /
- Esophagectomy /
- Complications /
- Efficacy /
- Therapy /
- Surgery
-
田文泽、尤振兵、张明志:文献查阅及论文撰写;陈梦舟、冷雪春、徐达夫、徐康:文献查阅,数据统计及分析;徐克平、蒋超、田文泽:研究方案制订,审阅及论文修改所有作者均声明不存在利益冲突田文泽, 尤振兵, 张明志, 等. 肌少症对食管鳞癌围手术期临床结局的影响[J]. 中华消化外科杂志, 2023, 22(11): 1322-1329. DOI: 10.3760/cma.j.cn115610-20230827-00036.
http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn115610-20230827-23036(new)
-
表 1 肌少症与非肌少症食管鳞癌患者的临床资料比较
Table 1 Comparison of clinical data between esophageal squamous cell carcinoma patients complicated with sarcopenia and patients without sarcopenia
患者类型 例数 性别(例) 年龄(x±s,岁) 高血压病史(例) 糖尿病史(例) 吸烟史(例) 肿瘤位置(例) 男 女 有 无 有 无 有 无 食管上段 食管中段 食管下段 肌少症 469 313 156 68±7 343 126 430 39 333 136 55 314 100 非肌少症 679 476 203 66±7 499 180 622 57 466 213 82 458 139 统计量值 χ²=1.46 t=-5.74 χ²=0.02 χ²=0.01 χ²=0.74 χ²=0.14 P值 0.227 <0.001 0.893 0.962 0.390 0.935 表 2 肌少症与非肌少症食管鳞癌患者的临床结局比较
Table 2 Comparison of clinical outcomes between esophageal squamous cell carcinoma patients complicated with sarcopenia and patients without sarcopenia
患者类型 例数 手术时间(x±s,h) 术后住院时间(x±s,d) 术后住院30 d内死亡(例) 术后住院时间>30 d(例) 肺炎(例) 急性呼吸衰竭(例) 吻合口瘘(例) 心律失常(例) 胸腔积液(例) 肌少症 469 3.8±1.0 17±9 9 32 158 39 33 103 26 非肌少症 679 3.8±1.0 15±6 5 15 102 18 19 85 33 统计量值 t=0.28 t=4.89 χ²=3.20 χ²=15.04 χ²=55.17 χ²=18.86 χ²=11.52 χ²=18.06 χ²=0.27 P值 0.781 <0.001 0.073 <0.001 <0.001 <0.001 <0.001 <0.001 0.606 表 3 影响1 148例食管鳞癌患者并发肌少症的单因素分析
Table 3 Univariate analysis of sarcopenia in 1 148 esophageal squamous cell carcinoma patients
临床病理因素 赋值 b值 标准误 Wald值 优势比 95%可信区间 P值 性别 男 0 0.16 0.13 1.46 1.17 0.91~1.51 0.227 女 1 年龄(岁) <65 0 0.59 0.13 20.03 1.79 1.39~2.32 <0.001 ≥65 1 高血压病史 无 0 0.02 0.14 0.02 1.02 0.78~1.33 0.893 有 1 糖尿病史 无 0 -0.01 0.22 0.01 0.99 0.65~1.52 0.962 有 1 吸烟史 无 0 -0.11 0.13 0.74 0.89 0.69~1.16 0.391 有 1 肿瘤长径(cm) ≥3 0 0.18 0.12 2.15 1.19 0.94~1.51 0.143 <3 1 肿瘤位置 食管上段 1 0.04 0.11 0.13 1.04 0.84~1.28 0.724 食管中段 2 食管下段 3 T分期 T1期 1 0.16 0.07 4.89 1.18 1.02~1.36 0.027 T2期 2 T3期 3 N分期 N0期 0 0.03 0.13 0.07 1.03 0.81~1.32 0.798 N+期 1 G分期 G1期 1 -0.07 0.10 0.50 0.93 0.77~1.13 0.481 G2期 2 G3期 3 术前白蛋白(g/L) <40 0 -0.35 0.17 4.56 0.70 0.51~0.97 0.033 ≥40 1 术前血清前白蛋白(mg/dL) <200 0 -0.58 0.12 22.45 0.56 0.44~0.71 <0.001 ≥200 1 腰大肌密度(HU) <48 0 -0.33 0.12 7.14 0.72 0.57~0.92 0.008 ≥48 1 体质量指数(kg/m2) ≤24 0 -0.64 0.13 25.26 0.53 0.41~0.68 <0.001 >24 1 表 4 影响1 148例食管鳞癌患者并发肌少症的多因素分析
Table 4 Multivariate analysis of sarcopenia in 1 148 esophageal squamous cell carcinoma patients
临床病理因素 b值 标准误 Wald值 优势比 95%可信区间 P值 年龄 0.50 0.13 13.66 1.64 1.26~2.14 <0.001 术前血清前白蛋白 -0.45 0.13 12.67 0.64 0.50~0.82 <0.001 腰大肌密度 -0.33 0.13 6.92 0.72 0.56~0.92 0.009 体质量指数 -0.63 0.13 23.03 0.53 0.41~0.69 <0.001 -
[1] XiaC, DongX, LiH, et al. Cancer statistics in China and United States,2022: profiles, trends, and determinants[J]. Chin Med J (Engl),2022,135(5):584‑590. DOI: 10.1097/CM9.0000000000002108.
[2] LiangH, FanJH, QiaoYL. Epidemiology, etiology, and prevention of esophageal squamous cell carcinoma in China[J]. Cancer Biol Med,2017,14(1):33‑41. DOI: 10.20892/j.issn.2095-3941.2016.0093.
[3] YangH, LiuH, ChenY, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): a phase Ⅲ multicenter, randomized, open‑label clinical trial[J]. J Clin Oncol,2018,36(27):2796-2803. DOI: 10.1200/JCO.2018.79.1483.
[4] YangY, TanL, HuJ, et al. Safety and efficacy of neoadjuvant treatment with immune checkpoint inhibitors in eso-phageal cancer: real‑world multicenter retrospective study in China[J]. Dis Esophagus,2022,35(11):doac031. DOI:10. 1093/dote/doac031.
[5] LiC, ZhaoS, ZhengY, et al. Preoperative pembrolizumab combined with chemoradiotherapy for oesophageal squamous cell carcinoma (PALACE‑1)[J]. Eur J Cancer,2021,144:232‑241. DOI: 10.1016/j.ejca.2020.11.039.
[6] ZhuH, MaX, YeT, et al. Esophageal cancer in China: practice and research in the new era[J]. Int J Cancer,2023,152(9):1741‑1751. DOI: 10.1002/ijc.34301.
[7] LiuJ, YangY, LiuZ, et al. Multicenter, single‑arm, phase Ⅱ trial of camrelizumab and chemotherapy as neoadjuvant treatment for locally advanced esophageal squamous cell carcinoma[J]. J Immunother Cancer,2022,10(3):e004291. DOI:10. 1136/jitc-2021-004291.
[8] 杨丁,毛友生.食管癌手术入路和淋巴结清扫范围的选择[J].中华胃肠外科杂志,2016,19(9):1069-1072. DOI: 10.3760/cma.j.issn.1671-0274.2016.09.027. [9] 吴汉然,徐美青,郭明发,等.胸腹腔镜联合食管癌根治术的临床应用[J].中华胃肠外科杂志,2014(9):938-939. DOI:10. 3760/cma.j.issn.1671-0274.2014.09.025. [10] 户安喜,李向楠,赵培峰,等.MIE联合辅助性化疗对局部晚期食管癌的疗效[J].中国现代普通外科进展,2019,22(2):155-157. DOI: 10.3969/j.issn.1009-9905.2019.02.022. [11] XuJ, YanC, LiZ, et al. Efficacy and safety of neoadjuvant chemoimmunotherapy in resectable esophageal squamous cell carcinoma: a meta‑analysis[J]. Ann Surg Oncol,2023, 30(3):1597‑1613. DOI: 10.1245/s10434-022-12752-1.
[12] WangH, LiS, LiuT, et al. Neoadjuvant immune checkpoint inhibitor in combination with chemotherapy or chemoradiotherapy in resectable esophageal cancer: a systematic review and meta‑analysis[J]. Front Immunol,2022,13:998 620. DOI: 10.3389/fimmu.2022.998620.
[13] SheikhM, RoshandelG, McCormackV, et al. Current status and future prospects for esophageal cancer[J]. Cancers (Basel),2023,15(3):765. DOI: 10.3390/cancers15030765.
[14] 翟博,张健,薛东波,等.食管癌术后胃穿孔1例[J].中国现代普通外科进展,2004,7(6):379. DOI: 10.3969/j.issn.1009-9905.2004.06.031. [15] GielenE, DupontJ, DejaegerM, et al. Sarcopenia, osteoporosis and frailty[J]. Metabolism,2023,145:155638. DOI:10. 1016/j.metabol.2023.155638.
[16] GengD, WuX, WangY, et al. Sarcopenia defined by the psoas muscle mass or quality is associated with poor survival in patients with aortic aneurysm undergoing surgery: a meta‑analysis[J]. Ageing Res Rev,2023,88:101964. DOI: 10.1016/j.arr.2023.101964.
[17] ShiY, ZhouL, YanE, et al. Sarcopenia and perioperative management of elderly surgical patients[J]. Front Biosci (Landmark Ed),2021,26(10):882‑894. DOI: 10.52586/4995.
[18] WahlenBM, MekkodathilA, Al‑ThaniH, et al. Impact of sarcopenia in trauma and surgical patient population: a literature review[J]. Asian J Surg,2020,43(6):647‑653. DOI: 10.1016/j.asjsur.2019.10.010.
[19] LinM, ShenY, WangH, et al. A comparison between two lung ventilation with CO(2) artificial pneumothorax and one lung ventilation during thoracic phase of minimally invasive esophagectomy[J]. J Thorac Dis,2018,10(3):1912-1918. DOI: 10.21037/jtd.2018.01.150.
[20] Gottlieb‑VediE, KauppilaJH, MattssonF, et al. Long‑term survival in esophageal cancer after minimally invasive esophagectomy compared to open esophagectomy[J]. Ann Surg,2022,276(6):e744‑e748. DOI:10.1097/SLA.000000 0000004645.
[21] ThakurB, DevkotaM, ThapaA. Trends in surgical management of esophageal cancer[J]. J Nepal Health Res Counc,2023,20(4):868‑874. DOI: 10.33314/jnhrc.v20i4.4202.
[22] YibulayinW, AbuliziS, LvH, et al. Minimally invasive oeso-phagectomy versus open esophagectomy for resectable esophageal cancer: a meta‑analysis[J]. World J Surg Oncol,2016,14(1):304. DOI: 10.1186/s12957-016-1062-7.
[23] MougSJ, BarryS, MaguireS, et al. Does prehabilitation modify muscle mass in patients with rectal cancer undergoing neoadjuvant therapy? A subanalysis from the REx randomised controlled trial[J]. Tech Coloproctol,2020,24(9):959‑964. DOI: 10.1007/s10151-020-02262-1.
[24] RenX, ZhangX, HeQ, et al. Prevalence of sarcopenia in Chinese community‑dwelling elderly: a systematic review[J]. BMC Public Health,2022,22(1):1702. DOI: 10.1186/s12889-022-13909-z.
[25] 展翰翔,李永政,胡三元.胰腺癌病人组织消耗与围术期处理策略[J].中华消化外科杂志,2021,20(4):407-413. DOI:10. 3760/cma.j.cn115610-20210217-00079. [26] 张知格,谈善军,吴国豪.欧洲临床营养与代谢协会肿瘤病人营养治疗实践指南解读[J].中华消化外科杂志,2021,20(12):1259-1271. DOI: 10.3760/cma.j.cn115610-20211110-00555. [27] WilliamsGR, DunneRF, GiriS, et al. Sarcopenia in the older adult with cancer[J]. J Clin Oncol,2021,39(19):2068-2078. DOI: 10.1200/JCO.21.00102.
[28] PamoukdjianF, BouilletT, LévyV, et al. Prevalence and predictive value of pre‑therapeutic sarcopenia in cancer patients: a systematic review[J]. Clin Nutr,2018,37(4):1101-1113. DOI: 10.1016/j.clnu.2017.07.010.
[29] 吴国豪.重视外科病人骨骼肌丢失的防治[J].中华消化外科杂志,2021,20(11):1158-1161. DOI:10.3760/cma.j.cn1156 10-20210804-00379. [30] ItoE, OhkiT, ToyaN, et al. Sarcopenia aneurysm scoring system predicts early and midterm mortality after endovascular repair for abdominal aortic aneurysm[J]. Ann Surg,2022,276(4):e247‑e254. DOI:10.1097/SLA.0000000000 0 04230.
[31] 徐骁,陈昊,鲁迪,等.肌肉减少症:肝移植的新挑战[J].中华消化外科杂志,2021,20(10):1025-1030. DOI: 10.3760/cma.j.cn115610-20210909-00449. [32] QiuJ, YangJ, YuY, et al. Prognostic value of pre-therapeutic nutritional risk factors in elderly patients with locally advanced esophageal squamous cell carcinoma receiving definitive chemoradiotherapy or radiotherapy[J]. BMC Cancer,2023,23(1):597. DOI: 10.1186/s12885-023-11044-5.
[33] AoyamaT, KazamaK, MaezawaY, et al. Usefulness of nutri-tion and inflammation assessment tools in esophageal cancer treatment[J]. In Vivo,2023,37(1):22‑35. DOI: 10.21873/invivo.13051.
[34] CaoY, HanD, ZhouX, et al. Effects of preoperative nutrition on postoperative outcomes in esophageal cancer: a systematic review and meta‑analysis[J]. Dis Esophagus,2022,35(3):doab028. DOI: 10.1093/dote/doab028.
[35] MotooriM, SugimuraK, TanakaK, et al. Comparison of syn-biotics combined with enteral nutrition and prophylactic antibiotics as supportive care in patients with esophageal cancer undergoing neoadjuvant chemotherapy: a multicenter randomized study[J]. Clin Nutr,2022,41(5):1112-1121. DOI: 10.1016/j.clnu.2022.03.023.
[36] 中华人民共和国国家卫生健康委员会医政医管局.食管癌诊疗指南(2022年版)[J].中华消化外科杂志,2022,21(10):1247-1268. DOI: 10.3760/cma.j.cn115610-20220726-00433. [37] JogiatUM, SasewichH, TurnerSR, et al. Sarcopenia determined by skeletal muscle index predicts overall survival, disease‑free survival, and postoperative complications in resectable esophageal cancer: a systematic review and meta-analysis[J]. Ann Surg,2022,276(5):e311‑e318. DOI: 10.1097/SLA.0000000000005452.
[38] ChalermsriC, AekplakornW, SrinonprasertV. Body mass index combined with possible sarcopenia status is better than BMI or possible sarcopenia status alone for predicting all‑cause mortality among asian community‑dwelling older adults[J]. Front Nutr,2022,9:881121. DOI: 10.3389/fnut.2022.881121.
[39] HiranoY, KanekoH, KonishiT, et al. Impact of body mass index on major complications, multiple complications, in-hospital mortality, and failure to rescue after esophagectomy for esophageal cancer: a Nationwide Inpatient Database Study in Japan[J]. Ann Surg,2023,277(4):e785‑e792. DOI: 10.1097/SLA.0000000000005321.
[40] 张天资,许勤,杨宁琍,等.基于加速康复的代谢手术围手术期营养管理研究进展[J].中华胃肠外科杂志,2017,20(4):477-480. DOI: 10.3760/cma.j.issn.1671-0274.2017.04.024. [41] 陈宁,何中元,赵良柱.肠内营养支持治疗在食管癌术后吻合口瘘患者中的应用效果[J].中华胃肠外科杂志,2016,19(9):1062-1064. DOI: 10.3760/cma.j.issn.1671-0274.2016.09.024. [42] TakenakaY, OyaR, TakemotoN, et al. Predictive impact of sarcopenia in solid cancers treated with immune checkpoint inhibitors: a meta‑analysis[J]. J Cachexia Sarcopenia Muscle,2021,12(5):1122‑1135. DOI: 10.1002/jcsm.12755.
[43] NachitM, LanthierN, RodriguezJ, et al. A dynamic associa-tion between myosteatosis and liver stiffness: results from a prospective interventional study in obese patients[J]. JHEP Rep,2021,3(4):100323. DOI: 10.1016/j.jhepr.2021.100323.
[44] LowDE, KuppusamyMK, AldersonD, et al. Benchmarking complications associated with esophagectomy[J]. Ann Surg,2019,269(2):291‑298. DOI:10.1097/SLA.000000000000 2611.
[45] GooszenJ, GoenseL, GisbertzSS, et al. Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer[J]. Br J Surg,2018,105(5):552‑560. DOI: 10.1002/bjs.10728.
[46] OzawaS, KoyanagiK, NinomiyaY, et al. Postoperative com-plications of minimally invasive esophagectomy for esopha-geal cancer[J]. Ann Gastroenterol Surg,2020,4(2):126-134. DOI: 10.1002/ags3.12315.
[47] 王正安,张建群,汪雁呜,等.食管贲门癌术后吻合口瘘的原因及预防[J].中国现代普通外科进展,2011,14(12):983,989. DOI: 10.3969/j.issn.1009-9905.2011.12.021. [48] 倪云峰,姜涛.食管癌术后远期生命质量影响因素的研究进展[J].中华消化外科杂志,2022,21(10):1342-1346. DOI:10. 3760/cma.j.cn115610-20220831-00483. [49] 柳硕岩,王枫,郑庆丰,等.腔镜食管癌根治术在食管癌治疗中的临床应用[J].中华胃肠外科杂志,2012,15(9):947-949. DOI: 10.3760/cma.j.issn.1671-0274.2012.09.020. [50] 吴汉然,徐美青,郭明发,等.胸腹腔镜联合食管癌根治术的临床应用[J].中华胃肠外科杂志,2014(9):938-939. DOI:10. 3760/cma.j.issn.1671-0274.2014.09.025. [51] ChenF, ChiJ, ZhaoB, et al. Impact of preoperative sarcopenia on postoperative complications and survival outcomes of patients with esophageal cancer: a meta‑analysis of cohort studies[J]. Dis Esophagus,2022,35(9):doab100. DOI: 10.1093/dote/doab100.
[52] JinSB, TianZB, DingXL, et al. The impact of preoperative sarcopenia on survival prognosis in patients receiving neoadjuvant therapy for esophageal cancer: a systematic review and meta‑analysis[J]. Front Oncol,2021,11:619592. DOI: 10.3389/fonc.2021.619592.