Does Skeletal Muscle Loss and Sarcopenia Predispose Patients for the Development of a Paraconduit Hernia After Minimally Invasive Esophagectomy? – A Propensity Matched Case-control Study

Background: Paraconduit hernia is a relatively common long-term complication after esophagectomy which has the potential to cause great morbidity and even mortality. The aim of this study is to examine the relationship between sarcopenia and muscle mass loss and paraconduit hernia after minimally invasive esophagectomy in esophageal adenocarcinoma patients who have received neoadjuvant treatment. Methods: All minimally invasive esophagectomies done for patients with neoadjuvant-treated esophageal or esophagogastric junction adenocarcinoma at our institution between 2008 and 2018 were included in this study. Propensity score matching was utilized to minimize confounding effects of retrospective data analysis. Computed tomography scans were used to measure skeletal muscle mass and to quantify sarcopenia. Results: The incidence of paraconduit hernia was 14 out of 171 patients (8.2%). The hernia was surgically repaired in 10 (71.4%) of patients. A total of 23 (82.1%) patients in the matched group were sarcopenic before start of neoadjuvant treatments, 22 (78.6%) after neoadjuvant treatments and 24 (85.7%) at 6 months of follow-up. Skeletal muscle area, skeletal muscle index or prevalence of sarcopenia had no correlation with paraconduit hernia developement. Using the median change of skeletal muscle area between pre-neoadjuvant and 6 months follow-up visit as a threshold to divide the patients into two equal size groups yielded no significantly different survival curves using Kaplan-Meier analysis (p = 0.6). Conclusion: Paraconduit hernia is a relatively common complication after minimally invasive esophagectomy for neadjuvantly treated adenocarcinoma patients. Sarcopenia and muscle mass loss are not predictive factors for paraconduit hernia.