Visceral Adipose Tissue Area on Ct Is Associated With Pulmonary and Cardiovascular Complications After Esophagectomy for Cancer

Background Visceral adipose tissue (VAT) is associated with postoperative complications following surgery for cancers such as pancreatic and colorectal. We report results of VAT area and its association with acute adverse outcomes in patients undergoing esophagectomy for cancer. Methods We performed a retrospective analysis of patients who underwent esophagectomy for cancer at a single institution. Pre-surgical computed tomography DICOM files underwent body segmentation at L3 using a semi-automated method. Muscle and VAT components were measured as cross-sectional area. The relationship between VAT and muscle areas and postoperative outcomes (categorized as pulmonary, cardiovascular (CV), or other) were analyzed. Results We included 157 patients with a median age of 63.2 years. Median BMI was 28.4 and most received neoadjuvant therapy (108; 69%). Median hospital stay was 9 days. 30-day mortality was 3.8%. 49 patients (31%) experienced at least one CV complication. 29 patients (18%) experienced at least one pulmonary complications. VAT and low density muscle (indicating fatty infiltration) areas were related to BMI, normal density muscle area was not. Patients in the highest quartile of VAT area experienced an increased incidence of postoperative pulmonary (p = 0.039) and CV (p = 0.012) complications (Figure). We identified no relationship between muscle area and acute outcomes. Conclusion In patients undergoing esophagectomy for cancer, high visceral adipose tissue area on CT was predictive of an increased incidence of postoperative pulmonary and cardiovascular complications. This association may be related to the endocrine effects of adipocytes and their activation of a proinflammatory state that increases with expanding fat volume. Further exploration of this relationship is needed as is identification of modifiable pharmacologic targets to minimize morbidity following esophagectomy.