Morphomic predictors for post-esophagectomy pulmonary complications and overall survival

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Key findings

• Increased visceral adipose tissue (VAT) density and decreased skeletal muscle (SM) area were identified as significant predictors of post-esophagectomy pulmonary complications.

• Decreased SM density was associated with poorer overall survival.

What is known and what is new?

• Esophagectomy following neoadjuvant chemoradiotherapy is a curative treatment for locally advanced esophageal cancer, but pulmonary complications are common postoperative issues that negatively impact survival.

• The present study investigates morphomic predictors, specifically derived from body composition measurements on computed tomography (CT) scans, delineating the association between increased VAT density, decreased SM area, and post-esophagectomy pulmonary complications, while also highlighting the link between decreased SM density and poorer overall survival.

What is the implication, and what should change now?

• Preoperative analytic morphomics can be a valuable tool in predicting both postoperative pulmonary complications and overall survival in esophageal cancer patients after esophagectomy, as identifying patients with increased VAT density and decreased SM area preoperatively can help tailor perioperative care to mitigate risks.

• Implement routine morphomic analysis using preoperative CT scans to better assess and manage the risk factors for pulmonary complications and overall survival, and develop targeted prehabilitation programs to improve SM density and optimize VAT density before surgery, potentially improving patient outcomes.

Publication: Chiu CH, Zhang P, Lin J, Chang AC, Ross BE, Enchakalody B, Shah NV, Liu YH, Chao YK, Wang SC. Morphomic predictors for post-esophagectomy pulmonary complications and overall survival. J Thorac Dis 2025;17(1):209-219. doi: 10.21037/jtd-24-1227