P1059 - CHANGES IN CT-DERIVED MUSCLE MASS AND DENSITY DURING PREHABILITATION IN PATIENTS UNDERGOING NACT AHEAD OF ESOPHAGECTOMY

P1059

CHANGES IN CT-DERIVED MUSCLE MASS AND DENSITY DURING PREHABILITATION IN PATIENTS UNDERGOING NACT AHEAD OF ESOPHAGECTOMY

M. Wobith^1,*, J. St-Pierre²

¹Surgery, National University Hospital Singapore, Singapore, Singapore, ²Anesthesia, Montreal General Hospital, Montreal, Canada

Rationale: Esophageal adenocarcinoma (EAC) patients routinely undergo neoadjuvant chemotherapy (NACT) and surgery with known deleterious effects on body composition and functional capacity. Prehabilitation has been postulated as a viable way to combat this decline, however, using CT scans to characterize changes has been scarcely studied. The aims were to a) investigate the impact of prehabilitation among patients treated with NACT using CT-derived measurements of muscle mass and quality as compared to control patients and b) determine their impact on postoperative outcomes.

Methods: A single-center retrospective cohort study was performed, including 61 patients (32 prehabilitation, 29 controls) with EAC treated with NACT and surgery between 2019 and 2022. CT scans at the third lumbar vertebra assessed skeletal muscle index (SMI) and skeletal muscle density (SMD) pre- and post-NACT. Outcome parameters included changes in SMI and SMD, NACT adherence, tumor regression grade, length of stay, and anastomotic leakage. Statistical analyses evaluated differences and correlations between groups.

Results: Prehabilitation patients showed no significant differences in SMI changes compared to controls. While SMD deterioration was significantly blunted (p<.001), SMI decreased significantly in prehab patients (p=.002). Adherence to protein intake correlated with improved SMD (p=.041) and reduced SMD decline (p=.028). SMD preservation was associated with reduced anastomotic leak rates (p=.001) and low SMD was correlated to impaired 6 Minute Walking distance.

Conclusion: SMD may serve as a prognostic marker for outcomes, highlighting the importance of individualized prehabilitation programs. Future research should refine patient selection and optimize multimodal interventions to improve outcomes. 

Disclosure of Interest: M. Wobith Grant / Research Support from: B Braun, Consultant for: Science for Life , Speakers Bureau of: Fresensius Kabi, J. St-Pierre: None declared