Clinical Value of Preoperative CT-Based Body Composition Analysis in Radical Resection of Esophageal Cancer

Objective: To calculate visceral fat area, skeletal muscle area and density at L3 level via preoperative CT images and analyze the correlation between body composition changes and postoperative complications of esophageal cancer radical resection. Methods: Data of patients who had esophageal cancer radical resection in the Department of Cardiothoracic Surgery of Jingzhou Central Hospital from January 2020 to December 2023 were retrospectively analyzed. Baseline, body composition, surgical data and postoperative complications were observed. Binary logistic regression was used to explore factors related to postoperative pulmonary infection. Results: 122 patients were included, with 113 males and 9 females, with a mean age of 61.3 years. Incidences of preoperative visceral obesity, sarcopenia and myosteatosis were 32.7% (40/122), 69.7% (85/122) and 66.4% (81/122), respectively. Incidences of postoperative complications like pleural effusion and pulmonary infection were 37.7% (46/122) and 30.3% (37/122). The risk of pleural effusion was lower in visceral obesity group (7.4% vs. 30.3%, P = 0.016). There was no significant difference in the distribution of postoperative complications of esophageal cancer between the sarcopenia group and the non-sarcopenia group. When comparing the myosteatosis group with the non-myosteatosis group, the operation time was shorter [(354 ± 71) min vs. (380 ± 61) min, P = 0.038], but the risk of developing pulmonary infection was higher (27.0% vs. 3.3%). Binary logistic regression analysis showed that the preoperative diagnosis of myosteatosis was an independent influencing factor for the occurrence of pulmonary infection after radical resection of esophageal cancer [odds ratio (OR) = 0.135, 95% confidence interval (CI): (0.041, 0.442), P = 0.001]. In addition, a history of alcohol consumption (OR = 3.124, 95% CI: 1.270 - 7.685, P = 0.013) and hemoglobin level (OR = 1.043, 95% CI: 1.011 - 1.076, P = 0.009) were also independent influencing factors for pulmonary infection. The prediction model established based on these independent influencing factors had an area under the curve (AUC) of 0.774, indicating a certain predictive ability. Conclusion: Preoperative CT can accurately reflect the patient’s body composition status to evaluate their nutritional status, and the changes in preoperative body composition are related to the occurrence of postoperative complications of esophageal cancer.