Hand-grip strength is a simple and effective outcome predictor in esophageal cancer following esophagectomy with reconstruction: a prospective study

Chih-Hao Chen, Ho-Chang, Yi-Zhen Huang, Tzu-Ti Hung, Chih-Hao Chen, Ho-Chang, Yi-Zhen Huang, Tzu-Ti Hung

Abstract

Background: Surgery for esophageal cancer usually carries considerable complication and mortality rate. Adequate preoperative evaluation is mandatory to decrease complication rate. Hand-grip strength is a useful measure to assess the extent of aging, nutrition and patient's overall condition. Because preoperative nutrition state and physiologic aging process play important roles in postoperative recovery, we would like to know if hand-grip strength is an adequate tool for such evaluation.

Material and methods: From January 1st, 2007 to December 31, 2008, there was 68 cases underwent esophagectomy with reconstruction due to esophageal cancer in our hospital. After excluding 7 patients of incomplete data and loss of follow-up, there were 61 patients included in the study.

Results: There were 54 men and 7 women. The mean age is 60.7. Most of patients had squamous cell carcinoma. Patient with weak hand-grip strength prior to operation had exceedingly high rates of complication and mortality within 6 months after operation. Compared to other risk factors, low grip strength has highest relative risks for both mortality and morbidity.

Conclusion: Because test for hand-grip strength is cheap, not time-consuming and has high predictive value, it may be included in routine preoperative evaluation.

Figures

Figure 1
Figure 1
The rates of complication and mortality in each group of hand-grip strength. It showed marked increased rates of complication and mortality when the strength of grip decreased. (p < 0.0001 and p = 0.003 respectively)
Figure 2
Figure 2
The odd ratio and relative risk of each risk factors for complication rate. Both weak hand-grip strength and diabetes were associated with more likelihood of complication. (p value less than 0.05) Abnormally elevated MCV has borderline significance.
Figure 3
Figure 3
The odd ratio and relative risks of each risk factor for mortality rate. Only weak hand-grip strength has significantly associated with more mortality rates. Other risk factors were not associated with mortality rate.
Figure 4
Figure 4
The figure showed that hand-grip strength does declined with age.
Figure 5
Figure 5
The hand-grip strength in mortality and survived patients was stratified according to age. The mean hand-grip strength in mortality patients is significantly lower than survived patients in the range from 51 to 60 years and 61 to 70 years.(p value was 0.024 and 0.014 respectively) The difference in patients older than 71 years old was not significant.
Figure 6
Figure 6
Receiver operating characteristic curve showed the most appropriate cut-off value is 25 kg for morbidity(A) and 22 kg for mortality(B).

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Source: PubMed

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