A Novel Frailty Grade Combined with Cachexia Index and Osteopenia in Esophagectomy.

BACKGROUNDS: The optimal method for evaluating frailty grade in patients with cancer has not been established in patients undergoing esophagectomy for esophageal cancer. This study aimed to clarify the impact of cachexia index (CXI) and osteopenia on survival in esophagectomized patients for esophageal cancer to develop frailty grade for risk stratification of the prognosis. METHODS: A total of 239 patients who underwent esophagectomy were analyzed. CXI was calculated as follows: skeletal muscle index × serum albumin/neutrophil-to-lymphocyte ratio. Meanwhile, osteopenia was defined as below the cutoff value of bone mineral density (BMD) calculated by the receiver operating characteristic curve. We evaluated the average Hounsfield unit within a circle in the lower midvertebral core of the 11th thoracic vertebra on preoperative computed tomography as BMD. RESULTS: Multivariate analysis revealed that low CXI (Hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.25-3.04) and osteopenia (HR, 1.86; 95% CI, 1.19-2.93) were independent prognostic factors for overall survival. Meanwhile, low CXI (HR, 1.58; 95% CI, 1.06-2.34) and osteopenia (HR, 1.57; 95% CI, 1.05-2.36) were also significant prognostic factors for relapse-free survival. A frailty grade combined with CXI and osteopenia stratified into four groups by their prognosis. CONCLUSIONS: Low CXI and osteopenia predict poor survival in patients undergoing esophagectomy for esophageal cancer. Furthermore, a novel frailty grade combined with CXI and osteopenia stratified the patients into four groups according to their prognosis.

Prognostic significance of the cachexia index in patients with stage I-III colorectal cancer who underwent laparoscopic surgery.

PURPOSE: The prognostic significance of the cachexia index, a novel biomarker of cancer cachexia, remains unclear in colorectal cancer; we, therefore, evaluated this relationship. METHODS: This retrospective cohort study included 306 patients with stage I-III colorectal cancer who underwent R0 resection between April 2010 and March 2020. The cachexia index was calculated as (skeletal muscle index [cm2/m2] × serum albumin level [g/dL])/neutrophil-to-lymphocyte ratio. The overall and disease-free survival rates were analyzed using a Cox proportional hazards model. RESULTS: A low cachexia index was found in 94 patients. This group had significantly lower disease-free survival and overall survival than the high-cachexia index group (5-year survival, 86.3% vs. 63.1%, p < 0.01; 87.9% vs. 67.2%, p < 0.01). Multivariate analyses showed that T3 or T4 (hazard ratio [HR]: 2.56; 95% confidence interval CI 1.04-6.25, p = 0.039), stage III (HR: 3.77; 95% CI 1.79-7.93, p < 0.01), and a low cachexia index (HR: 2.27; 95% CI 1.31-3.90, p = 0.003) were significant independent predictors of the disease-free survival. CA19-9 ≥ 37.0 ng/mL (HR: 2.68; 95% CI: 1.37-5.24, p = 0.004), stage III (HR: 2.57; 95% CI 1.34-4.92, p = 0.004), and a low cachexia index (HR: 2.35; 95% CI 1.31-4.21, p = 0.004) were significant independent predictors of the overall survival. CONCLUSION: A low cachexia index might be a long-term prognostic factor of colorectal cancer.

[A rare case of diencephalic cachexia in an adult female with cranio-pharyngioma]. / Redkii sluchai razvitiia diéntsefal'noi kakheksii u vzrosloi zhenshchiny s kraniofaringiomoi.

Diencephalic cachexia (DС) is progressive weight loss despite a normal caloric intake and a satisfactory state of health, which is caused by hypothalamic lesions. This is a rare (about 100 cases were reported) and potentially fatal disorder of unknown pathogenesis. At present, there is no effective pharmacological therapy for the disorder. Cachexia may regress only if the tumor reduces in size, therefore the timely diagnosis and treatment are of vital importance for the patient. DС is typical of early childhood, and only a few cases have been reported in adults. We present a rare case of DС in a 24-year-old female with papillary craniopharyngioma.

Staged management of a primary aortobronchial fistula: a novel approach using a trapezius flap repair.

There have been few reported cases of management of an aortobronchial fistula. We describe the case of a 68 year-old male with a very high operative risk who had a successful staged management of a primary aortobronchial fistula. An endovascular stent was placed initially, however due to recurrence of the fistula a second stent was deployed within the first one some three months after. Fifteen months later he represented with massive haemoptysis, severe cachexia and at this stage the best course of surgical management was thought to be lobectomy via thoracotomy followed by trapezius flap overlay covering the exposed stent and separating it from the remaining lung.

[Surgical treatment of tricuspid valve disease combined with cardiac cachexia syndrome].

OBJECTIVE: To evaluate the surgical treatment of tricuspid valve disease combined with cardiac cachexia. METHODS: Seven patients with heavy tricuspid valve disease combined with cardiac cachexia underwent tricuspid valve replacement. Heart function and nutrition status were improved in the perioperative period. RESULT: All operations were performed successfully, but one patient died of heavy heart failure postoperatively. The mean follow-up length was 32 months, all patients had good heart function except one with minor right heart function failure. CONCLUSION: Prosthetic heart valve replacement is an effective treatment for patients with serious tricuspid valve disease combined with cardiac cachexia. The perioperative nutrition support and heart function improvement are important in the treatment process.

Factors affecting postoperative ventilatory support in patients with cardiac cachexia.

Factors affecting early v late weaning from ventilatory support after cardiac surgery were retrospectively compared in 15 patients with cardiac cachexia. These patients were divided into two groups based on the duration of postoperative ventilatory support, group I (n = 7) less than two days (22 +/- 8 hours) and group II (n = 8) over three days (140 +/- 125 hours). Findings in 14 randomly selected patients without cardiac cachexia who underwent cardiac valve replacement were also examined. Comparisons were made between the groups in regards to the following parameters: (1) preoperatively: anthropometric, biochemical, and immunologic parameters of nutritional status, hepatic function, cardiothoracic ratio (CTR) on chest x-ray, and data from cardiac catheterization; (2) intraoperatively and postoperatively: anesthetic drugs, duration of surgery, cardiopulmonary bypass (CPB), aortic cross-clamp, and postoperative use of inotropes. The anthropometric measurements, cell-mediated immunity, and hepatic function were significantly decreased in all patients with cachexia, but with no significant differences between the groups. Serum transferrin levels, which increased in patients with cachexia, showed no significant difference between the groups. The levels of serum albumin were significantly lower in cachectic patients than in patients without cachexia; they were significantly higher in group II than in group I. The durations of surgery and CPB were significantly longer in group II, but there was no significant difference in the duration of aortic clamping between the groups. The postoperative use of inotropes was higher in group II. These results indicate that group II patients were nutritionally as well sustained as group I. However, they had less satisfactory cardiac function, and therefore required a longer duration of postoperative ventilatory support.