Skeletal muscle mass and quality before preoperative chemotherapy influence postoperative long-term outcomes in esophageal squamous cell carcinoma patients

BACKGROUND Previous reports have focused on muscle mass as a prognostic factor in esophageal cancer.AIM To investigate how preoperative body type influences the prognosis of patients with esophageal squamous cell carcinoma who underwent neoadjuvant chemotherapy(NAC)and surgery.METHODS The subjects were 131 patients with clinical stage Ⅱ/Ⅲ esophageal squamous cell carcinoma who underwent subtotal esophagectomy after NAC.Skeletal muscle mass and quality were calculated based on computed tomography images prior to NAC,and their statistical association with long-term outcomes was examined retrospectively in this case-control study.RESULTS The disease-free survival rates in the low psoas muscle mass index(PMI)group vs the high PMI group were 41.3%vs 58.8%(P=0.036),respectively.In the high intramuscular adipose tissue content(IMAC)group vs the low IMAC group,the disease-free survival rates were 28.5%vs 57.6%(P=0.021),respectively.The overall survival(OS)rates for the low PMI group vs the high PMI group were 41.3%vs 64.5%(P=0.008),respectively,and for the high IMAC group vs the low IMAC group,they were 29.9%vs 61.9%(P=0.024),respectively.Analysis of the OS rate revealed significant differences in patients aged 60 years or older(P=0.018),those with pT3 or above disease(P=0.021),or those with lymph node metastasis(P=0.006),aside from PMI and IMAC.Multivariate analysis demonstrated that pT3 or above hazard ratio(HR):1.966,95%confidence interval(CI):1.089-3.550,(P=0.025),lymph node metastasis(HR:2.154,95%CI:1.118-4.148,P=0.022),low PMI(HR:2.266,95%CI:1.282-4.006,P=0.005),and high IMAC(HR:2.089,95%CI:1.036-4.214,P=0.022)were significant prognostic factors for esophageal squamous cell carcinoma.CONCLUSIONSkeletal muscle mass and quality before NAC in patients with esophageal squamous cellcarcinoma are significant prognostic factors for postoperative OS.

Resection of a locally advanced hilar tumor and the hepatic artery after stepwise hepatic arterial embolization: A case report

We herein report a case of a hilar tumor with extensive invasion to the proper hepatic artery, which was successfully treated with a radical resection in a 57-year-old female patient after a stepwise hepatic arterial embolization. She underwent right colectomy and partial hepatectomy for advanced colon cancer two years ago and radiofrequency ablation therapy for a liver metastasis one year ago, respectively. A recurrent tumor was noted around the proper hepatic artery with invasion to the left hepatic duct and right hepatic artery 7 mo previously. We planned a radical resection for the patient 5 mo after the absence of tumor progression was confirmed while he was undergoing chemotherapy. To avoid surgery-related liver failure, we tried to promote the formation of collateral hepatic arteries after stepwise arterial embolizationof the posterior and anterior hepatic arteries two weeks apart. Finally, the proper hepatic artery was occluded after formation of collateral flow from the inferior phrenic and superior mesenteric arteries was confirmed. One month later, a left hepatectomy with hepatic arterial resection was successfully performed without any major complications.