Comparing glycaemic benefits of active versus passive lifestyle intervention in kidney allograft recipients (CAVIAR): a randomised controlled trial', Transplantation.

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Background Patients with oesophago-gastric (OG) cancer are one of the highest risk groups for malnutrition. Nutrition plays a vital role in supporting this patient group. NICE guidelines (2018) recommend adults with OG cancer have tailored specialist dietetic support before, during and after radical treatment. Unfortunately the research available suggests there are low rates of preoperative dietetic input in this population, which are associated with poorer outcomes. Methods Data was obtained via informatics looking at patients who had an oesophagectomy or total gastrectomy between the years of March 2018 –2020 and were followed up at the Queen Elizabeth Hospital Birmingham. A sample of 66 patients was taken. Data was collected on the surgery type, weight changes and whether there was any dietetic input before and / or after surgery. Results 79% (52) patients had an oesophagectomy and 21% (14) had a total gastrectomy. Weight loss across all patients post-surgery was apparent post op at 3, 6 and 12 months. Clinically significant weight loss (>10%) was demonstrated at 3 months (27%), 6 months (17%) and 12 months (26%). Unfortunately data was not available for 20% (6 months) and 36% at (12 months). Only 16 (24%) patients were known to a dietitian pre-op. Out of these 8 (50%) had a feeding tube inserted pre-operatively, 7 of the patients used the tube for enteral feeding. 5 (31%) were seen for oral nutrition support and 3 (19%) for food first approach. 100% of patient had a feeding tube inserted following surgery. 100% of patients had been seen by a dietitian post op both as an inpatient and outpatient. The percentage of patients seen by a dietitian prior to surgery that had clinically significant weight loss post-op was less than those that were not seen by a dietitian pre op (ie 19% vs 24% at 6 months respectively). Conclusions Patients that undergo OG surgery experience clinically significant weight loss postoperatively. The data collected highlights that dietetic input pre-op can lead to less weight loss following surgery. Additional dietetic funding and the set up of a pre-treatment clinic would enable more patients to be seen prior to surgery. Further research needs to be done with a larger sample size over a longer time-frame to provide more representative results on the effects of dietetic input both pre and post surgery.

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