Physical fitness predicts post-esophagectomy complications after chemoradiotherapy: a pilot study

Esophagectomy following neoadjuvant chemoradiotherapy or definitive chemoradiotherapy has been shown to yield favorable oncological outcomes in patients with locally advanced esophageal squamous cell carcinoma. However, postoperative complications are frequent and can adversely affect patient survival. This study aimed to identify physical fitness factors across multiple domains associated with major postoperative complications.

This study enrolled patients with esophageal squamous cell carcinoma who were treated with neoadjuvant chemoradiotherapy or definitive chemoradiotherapy and underwent esophagectomy between 2020 and 2022. Multivariate logistic regression analysis was conducted to identify the factors associated with major postoperative complications. Additionally, a tree-based learning process was employed to assess all the variables influencing major complications.

A total of 142 esophageal cancer patients who underwent esophagectomy were screened. Of these, 72 eligible patients were included in the study, and 29 (40.2%) experienced major postoperative complications. In the full model, factors such as low body weight, low body mass index, low peak oxygen consumption (V̇O_2peak), low V̇O_2peak/skeletal muscle mass (SMM), low appendicular skeletal muscle index (ASMI), and low ASMI-V̇O_2peak/SMM product (AV̇P) were found to be significantly associated with major postoperative complications. However, in the parsimonious model, only low AV̇P (P < 0.01) was associated with major complications. Additionally, AV̇P, EqO₂nadir, and hand grip strength emerged as the key predictors of major post-esophagectomy complications in the tree-based learning analysis, which showed a sensitivity of 0.448, specificity of 0.977, and accuracy of 76.4%, with false negative and false positive rates of 55.2% and 2.3%. AV̇P alone yielded similar results.

Patients with low AV̇P, high EqO₂nadir, and low HGS are at a very high risk of experiencing major postoperative complications, with low AV̇P showing the strongest correlation. Preoperative physical fitness screening can help identify high-risk patients and guide appropriate perioperative management.