Patterns of Symptoms Following Surgery for Esophageal Cancer

Ginex, Pamela; Thom, Bridgette; Jingeleski, Maureen; Vincent, A.; Plourde, Gabriel; Rizk, Nabil P.; Rusch, Valerie W.; Bains, Manjit S.

doi:10.1188/13.onf.e101-e107

Cited by 26 publications

(40 citation statements)

References 20 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%

“…No studies assessed the relationship between inadequacy of nutritional intake and change in nutritional status post-operatively. Table 4 summarises the six studies reporting change in nutritional status that also reported on nutrition related symptoms or quality of life [17,22,23,25,27,33]. Two of the studies employed a validated instrument in the assessment of patient reported outcomes [22,23].…”

Section: Changes In Dietary Intakementioning

confidence: 99%

“…[33] n/r n/r n/r Posterior mediastinum in 83% Cervical in 83% n/r n/r = not reported, [22] 200 of 208 patients reported underwent Ivor Lewis esophagogastrectomy. The procedure was not stated for eight patients.…”

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 Dietary Intakementioning

confidence: 99%

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A systematic review of the nutritional consequences of esophagectomy

et al. 2016

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“…Dysphagia is a very common mechanical cause of malnutrition and is accompanied by dietary changes in order to avoid foods that worsen symptoms leading to inadequate intake of calories. The surgical procedure often causes deficiencies in macronutrients and micronutrients, with the most prevailing side effects being postprandial dumping syndrome, dysphagia, anorexia, reflux, and early satiety [53][54][55]. Furthermore, chemotherapy affects rapidly proliferating cells preferentially and, consequently, affects the cells of the gastrointestinal tract.…”

Section: Mechanisms Of Malnutritionmentioning

confidence: 99%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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Esophageal cancer is associated with malnutrition in the vast majority of patients. This phenomenon is partly attributed to the disease process itself, the location of the tumor and other factors, such as dysphagia which is often accentuated due to chemotherapy/ radiotherapy treatment or surgical intervention. The poor nutritional status of these patients is often related to the presence of cancer cachexia, altered metabolism, and tissue wasting. Malnutrition in this patient population affects quality of life, worsens patient's tolerance to chemotherapy and accounts for lower survival. Nutritional management of these patients includes both proper nutritional assessment and support and might prevent, to a certain extent, the manifestation of malnutrition-related consequences. The purpose of this article is to review the current literature in order to focus on the etiology and diagnosis of malnutrition in esophageal cancer patients, emphasizing also on the optimal nutritional support during multimodality treatment.

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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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Patterns of Symptoms Following Surgery for Esophageal Cancer

Abstract: Patients with esophageal cancer are at risk for multiple prolonged symptoms following surgery. Symptom assessment should occur often after surgery and include a broad range of symptoms.

Cited by 26 publications

References 20 publications

A systematic review of the nutritional consequences of esophagectomy

A systematic review of the nutritional consequences of esophagectomy

Nutritional Management of Esophageal Cancer Patients

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

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