Abstract

The aim of this study was to evaluate the impact of a preoperative feeding jejunostomy (FJ) on the occurrence of sarcopenia before and after preoperative chemotherapy for patients with an oesogastric adenocarcinoma (OGA). Forty-six patients with potentially resectable OGA were enrolled in a perioperative chemotherapy protocol. Sarcopenia was evaluated by measuring muscle surfaces (psoas, paraspinal and abdominal wall muscles) on abdominal CT images at the level of the 3rd lumbar vertebra. A FJ was placed in 31 patients (67.4%) before the neoadjuvant treatment (FJ group), while 15 patients (32.6%) started neoadjuvant treatments without FJ (control group). After preoperative chemotherapy, there were significantly more sarcopenic patients in the control group, compared to the FJ group. In the FJ group, 13% of the patients (n = 4) were sarcopenic before treatment and 22.6% of them (n = 7) became sarcopenic after preoperative chemotherapy (p = 0.3). In the control group, if initially only 6.7% (n = 1) of patients were sarcopenic, the majority of the patients (60%, n = 9) became sarcopenic after chemotherapy (p = 0.012). The FJ was an independent risk factor of sarcopenia after neoadjuvant chemotherapy. FJ with enteral nutritional support during the preoperative management of OGA seemed to efficiently counteract sarcopenia occurrence during preoperative chemotherapy.

摘要

本研究的目的是评估术前空肠造口术 (FJ) 对食管胃腺癌 (OGA) 患者术前化疗前后肌肉减少症发生的影响。46 名可能可切除的 OGA 患者参加了围手术期化疗方案。通过测量第三腰椎水平的腹部 CT 图像上的肌肉表面（腰大肌、脊柱旁和腹壁肌肉）来评估肌肉减少症。31 名患者（67.4%）在新辅助治疗前（FJ 组）放置了 FJ，而 15 名患者（32.6%）在没有 FJ 的情况下开始了新辅助治疗（对照组）。术前化疗后，对照组的肌肉减少症患者明显多于 FJ 组。在 FJ 组中，13% 的患者 ( n = 4) 在治疗前肌肉减少，其中 22.6% ( n  = 7) 在术前化疗后变成肌肉减少 ( p  = 0.3)。在对照组中，如果最初只有 6.7% ( n  = 1) 的患者出现肌肉减少症，那么大多数患者 (60%, n  = 9) 会在化疗后出现肌肉减少症 ( p  = 0.012)。FJ是新辅助化疗后肌肉减少症的独立危险因素。在 OGA 术前管理期间进行肠内营养支持的 FJ 似乎有效地抵消了术前化疗期间肌肉减少症的发生。