Malnutrition after oesophageal cancer surgery in Sweden

Martin, Lena; Lagergren, Jesper; Lindblad, Mats; Rouvelas, Ioannis; Lagergren, Pernilla

doi:10.1002/bjs.5881

Cited by 118 publications

(90 citation statements)

References 18 publications

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“…Further details of the studies are given in Table 1. In general, all studies were considered deficient in one or more aspects of their study design/ reporting, which increased the likelihood of bias. In terms of selection, no eligibility criteria were reported in two studies [17,26], one prospective study used consecutive patients attending outpatient clinics [18] and all others used convenient samples from defined time periods [19][20][21][22][23][24][25][27][28][29][30][31][32][33]. Participation rate was reported in 16 of the 18 studies, and ranged between 66 and 100%.…”

Section: Resultsmentioning

confidence: 99%

“…A number of studies considered the frequency of malnutrition, defined by a greater than 10% or 15% loss of baseline weight [21,28,29,32] These found that at six and 12 months after surgery, more than half of the patients had lost more than 10% of their initial weight.…”

Section: Changes In Nutritional Statusmentioning

confidence: 99%

“…Ogendo [31] n/r n/r 52% n/r n/r Ryan et al [7] % of patients with ≥5% weight loss 50% n/r n/r n/r n/r D'Journo et al [21] % of patients with ≥10% weight loss n/r n/r 54% 55% n/r Martin et al [28] % of patients with ≥10% weight loss n/r n/r 64% n/r n/r Martin et al [29] % of patients with ≥15% weight loss n/r n/r n/r n/r 33% (36 m)…”

Section: Authormentioning

confidence: 99%

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A systematic review of the nutritional consequences of esophagectomy

et al. 2016

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SummaryBackground & aims-As improved outcomes after esophagectomy have been observed over the last two decades, the focus on care has shifted to survivorship and quality of life. The aim of this review was to determine changes in nutrition after esophagectomy and to assess the evidence for extended nutrition support.Methods-A search strategy was developed to identify primary research reporting change in nutritional status a minimum of one month after esophagectomy.Results-Changes in nutritional parameters reported by 18 studies indicated a weight loss of 5-12% at six months postoperatively. More than half of patients lost >10% of body weight at 12 months. One study reported a persistent weight loss of 14% from baseline three years after surgery. Three studies reporting on longer term follow up noted that 27%-95% of patients failed to regain their baseline weight. Changes in dietary intake (three studies) indicated inadequate energy and protein intake up to three years after surgery. Global quality of life scores reported in one study correlated with better weight preservation. There were a high frequency of gastrointestinal symptoms reported in six studies, most notably in the first year after surgery, but persisting up to 19 years. Extended enteral nutrition on a selective basis has been reported in several studies.Conclusions-Nutritional status is compromised in the months/years following oesophagectomy and may never return to baseline levels. The causes/consequences of weight loss/ impaired nutritional intake require further investigation. The role of extended nutritional support in this population remains unclear.

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Section: Resultsmentioning

confidence: 99%

Section: Changes In Nutritional Statusmentioning

confidence: 99%

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A systematic review of the nutritional consequences of esophagectomy

et al. 2016

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“…Table 7 summarizes the studies reporting on the most common patient symptoms after surgery. 4,11,42,[44][45][46][47][48][49][50][51][52][53] These indicate a high prevalence of gastrointestinal symptoms. In studies reporting at 12 months or more, symptoms were seen with the following frequency: dumping syndrome 15%-75% (median 46%), dysphagia 11%-38% (median 27%), early satiety 40%-90% (median 65%) and reflux symptoms 19%-61% (median 29%).…”

Section: Later Challenges Nutrition and Weightmentioning

confidence: 99%

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

Paul¹,

Baker²,

Williams³

et al. 2017

NDS

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Background and aims: Provision of adequate nutrition after esophagectomy remains a major challenge. The aims of this review were to describe the challenges facing this patient population and to determine the evidence base underpinning current nutritional and dietetic interventions after esophagectomy. Methods: Medline, Embase and CINAHL databases were searched for English language publications of the period 1990-2016 reporting on the outcome of nutritional or dietetic interventions after esophagectomy or patient-related symptoms. Results: Four studies demonstrated that early reintroduction of oral fluids was safe and was associated with a shorter hospital stay and ileus duration. One of three studies comparing in-hospital enteral nutrition against usual care showed that enteral feeding was well tolerated and was associated with a shorter hospital stay. Eight studies comparing enteral with parenteral nutrition showed similar surgical complication rates. Enteral feeding was associated with a shorter duration of ileus and lower health care costs. In hospital, all types of enteral access (nasoenteral, jejunostomy) were equivalent in their safety profiles. Cohort studies indicate that technical (tube dysfunction) and feed (diarrhea, distention) problems were common with jejunostomies but are easily managed. The mortality risk associated with jejunostomy in hospital is 0.2% (reported range 0%-1%), principally due to small bowel ischemia. There have been no reports of serious jejunostomy complications in patients receiving home feeding. One study demonstrated the advantages of home feeding in weight, muscle and fat preservation. Studies reporting 12 months or more after esophagectomy indicate a high frequency of persistent symptoms, dumping syndrome 15%-75% (median 46%), dysphagia 11%-38% (median 27%), early satiety 40%-90% (median 65%) and reflux 19%-61% (median 29%). Conclusion: Patients should resume oral intake as soon as possible after surgery. In hospital, all forms of enteral access appear to be safe. Out of hospital, the ability to provide home feeding by feeding jejunostomy is likely where meaningful nutritional improvements can be made. Improving nutrition and related quality of life in the early months might improve the long-term outcome.

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“…Occurrence of these symptoms can contribute to weight loss and are detrimental to the overall nutritional status of patients [2][3][4][5]. Furthermore, use of adjunctive chemo-and radio-therapy either before or after surgery may further exacerbate these symptoms.…”

Section: Introductionmentioning

confidence: 99%

Micronutrient Deficiency Following Esophagectomy for Cancer of the Upper Gastrointestinal Tract

Boshier¹,

Wakefield²,

Hickson³

et al. 2017

Vitam Miner

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Objectives: For those patients who achieve long-term survival following esophagectomy, altered digestion and malabsorption may lead to a range of adverse gastrointestinal sequelae, including micronutrient deficiencies. The aim of the current study was to determine the prevalence of specific micronutrient deficiencies in patients following esophagectomy.Methods: Levels of vitamin A, vitamin E, vitamin D, vitamin B1, vitamin B12, folate, ferritin, zinc and calcium were measured in a single non-fasting blood sample in patients who had undergone esophagectomy. Findings were compared to both patients who had undergone gastrectomy and an age matched Western control population.Results: Forty-Four patients (33 male, 65.5 ± 10.2 yrs) a median of 26 months (IQR 12-46) following either two or three stage esophagectomy were recruited. Deficiency in one or more micronutrients was observed in 64% of patients who underwent esophagectomy. Micronutrients most commonly deficient following esophagectomy were vitamin D (21%), vitamin B12 (32%), ferritin (16%) and zinc (25%). Compared to patients who underwent gastrectomy, levels of vitamin B12 and red cell folate were significantly lower, and levels of vitamin E were significantly higher in the blood of patients following esophagetomy. Compared to a Western control population the mean levels of vitamins A, E, D and B12, ferritin and zinc were lower in patients following esophagectomy. Conclusion:Micronutrient deficiency is common after esophagectomy affecting two thirds of all patients. Regular screening of vitamin D, vitamin B12, ferritin and Zinc levels should be considered as well as prophylactic supplementation in this patient group to prevent deficiency.

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Malnutrition after oesophageal cancer surgery in Sweden

Abstract: Malnutrition is a considerable problem after oesophagectomy, and is linked to appetite loss, eating difficulties and odynophagia.

Cited by 118 publications

References 18 publications

A systematic review of the nutritional consequences of esophagectomy

A systematic review of the nutritional consequences of esophagectomy

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

Micronutrient Deficiency Following Esophagectomy for Cancer of the Upper Gastrointestinal Tract

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