Prognostic Implication of Postoperative Weight Loss After Esophagectomy for Esophageal Squamous Cell Cancer

Kubo, Yuto; Miyata, Hiroshi; Sugimura, Keijiro; Shinno, Naoki; Asukai, Kei; Hasegawa, Shinitiro; Yanagimoto, Yoshitomo; Yamada, Daisaku; Yamamoto, Keiji; Nishimura, Junichi; Wada, Hiroshi; Takahashi, Hidenori; Yasui, Masayoshi; Omori, Takeshi; Ohue, Masayuki; Yano, Masahiko

doi:10.1245/s10434-020-08762-6

Cited by 25 publications

(13 citation statements)

References 30 publications

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“…Postoperative nutritional support could improve quality of life and possibly improves long-term outcomes. Although several studies suggested that malnutrition after esophagectomy was associated with poor survival of patients [31-33], the current study did not show the association.…”

Section: Discussioncontrasting

confidence: 94%

Long-Term Insufficiency of Oral Intake after Esophagectomy: Who Needs Intense Nutritional Support after Esophagectomy?

Kanie

Okamura

Fujihara³

et al. 2022

Ann Nutr Metab

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Background. Patients with esophageal cancer are at a high risk of malnutrition after esophagectomy, and nutritional support may at times be required for several months following surgery. In this study, we aimed to clarify the clinical features and preoperative risk factors of patients with long-term insufficiency of oral intake after esophagectomy by evaluating the duration of feeding enterostomy placement. Methods. A total of 306 patients who underwent esophagectomy, reconstruction with gastric conduit, and feeding enterostomy creation were retrospectively reviewed. We analyzed the clinical features and preoperative risk factors for long-term placement of feeding enterostomy. Results. The feeding enterostomy tube was removed less than 90 days after esophagectomy in 234 patients (76.5%) (Short group), whereas 72 patients still needed enteral nutrition after 90 days (23.5%; Long group). Although severe malnutrition was observed more frequently in the long group compared with the short group (p=0.021), overall survival time was comparable between the groups (p=0.239). Multivariate analysis revealed that higher age (OR 1.04; 95% CI, 1.01–1.07; p=0.021), poor performance status(OR 2.94; 95% CI, 1.10–7.87; p=0.032), and lower preoperative body weight(OR 0.96; 95% CI, 0.94–0.99; p=0.009) were the independent variables predicting the long-time placement of feeding enterostomy. Conclusion. Nutritional support via feeding enterostomy for more than 90 days after esophagectomy was required in 23.5% of patients. The elderly, poor performance status, and lower body weight were the independent preoperative factors for predicting the long-term placement of feeding enterostomy.

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Section: Discussioncontrasting

confidence: 94%

Long-Term Insufficiency of Oral Intake after Esophagectomy: Who Needs Intense Nutritional Support after Esophagectomy?

Kanie

Okamura

Fujihara³

et al. 2022

Ann Nutr Metab

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“…Furthermore, one previous study demonstrated that severe transthyretin, which decreased after esophagectomy, was shown to be a risk factor for anastomotic leak after MIE [28]. Thus, an enhanced recovery protocol can also be beneficial for the improvement of prognosis for patients with esophageal cancer [29]. On the other hand, the change in biochemical nutritional data was not significant in either group in this study.…”

Section: Discussioncontrasting

confidence: 50%

Feasibility of enhanced recovery protocol in minimally invasive McKeown esophagectomy

et al. 2021

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Background Implementation of enhanced recovery after surgery has generally been applied to gastrointestinal surgeries; however, few studies have investigated minimally invasive McKeown esophagectomy. In this study, we aimed to evaluate the safety and feasibility of an enhanced recovery protocol after minimally invasive McKeown esophagectomy. Methods Data were collected between January 2015 and April 2020 for patients who underwent esophagectomy. Of these patients, those who underwent minimally invasive McKeown esophagectomy was selected for the investigation. Perioperative outcomes and nutritional index were compared using propensity score matching between the conventional group and the enhanced recovery group. Results A total of 119 patients were enrolled in this study. Of these, 73 and 46 were treated with conventional and enhanced recovery protocol, respectively. Forty-two pairs were matched in two groups. The enhanced recovery group showed a lower rate of pulmonary complications (9.5% vs. 28.5%, p = 0.0235), abdominal dysfunctions (16.7% vs. 42.9%, p = 0.0078), and shorter hospital stay as compared with the conventional group (17.5 days vs. 23 days, p = 0.0034). The loss of body weight (6.3% vs. 7.7%, p = 0.0065) and body mass index (5.6% vs. 8.1%, p = 0.0017) were significantly lower in the enhanced recovery group than in the conventional group. In contrast, nutritional biochemistry data did not differ significantly between the two groups. Conclusions This study shows that the promotion of an enhanced recovery protocol in minimally invasive McKeown esophagectomy maintains nutritional status without increasing postoperative complications.

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“…Meanwhile, as a systemic treatment, all types of adjuvant therapy may cause adverse systemic effects on patients [ 21 ]. Especially for ESCC patients, prolonged fasting or reduce of meal could lead to poor nutritional status, which makes them frailer after receiving adjuvant therapy [ 22 , 23 ]. Moreover, the unfavorable impact of adjuvant therapy on the immune system could further weaken the patient’s resistance to the tumor, leading to tumor recurrence after adjuvant therapy [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Trimodal Therapy in Esophageal Squamous Cell Carcinoma: Role of Adjuvant Therapy Following Neoadjuvant Chemoradiation and Surgery

Luan

Yang

et al. 2022

Cancers

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Background: The aim of this study was to determine the role of adjuvant therapy after neoadjuvant chemoradiotherapy and esophagectomy for esophageal squamous cell carcinoma (ESCC). Methods: The study retrospectively reviewed 447 ESCC patients who underwent neoadjuvant chemoradiotherapy and esophagectomy. Patients were divided into an adjuvant therapy group and no adjuvant therapy group. Propensity score matching was used to adjust the confounding factors. Results: 447 patients with clinical positive lymph nodes and no distant metastasis treated with neoadjuvant chemoradiotherapy and esophagectomy were eligible for analysis. After propensity score matching, there were 120 patients remaining in each group. Patients receiving adjuvant therapy had a significantly shorter post-resection overall survival (OS) and disease-free survival (DFS) when compared to patients not receiving adjuvant therapy (log-rank, OS: p = 0.046, DFS: p < 0.001). Receiving adjuvant therapy is not an independently prognostic factor for OS (hazard ratio (HR): 1.270, HR: 0.846–1.906, p = 0.249) but a significantly unfavorable independent prognostic factor for DFS (HR: 2.061, HR: 1.436–2.958, p < 0.001). Conclusions: The results of our study indicate that adjuvant therapy after neoadjuvant chemoradiotherapy and surgery could reduce the OS and DFS in patients with ESCC. Therefore, adjuvant therapy is not recommended for ESCC patients after neoadjuvant chemoradiotherapy and esophagectomy, especially patients without nodal metastases after neoadjuvant therapy.

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Prognostic Implication of Postoperative Weight Loss After Esophagectomy for Esophageal Squamous Cell Cancer

Cited by 25 publications

References 30 publications

Long-Term Insufficiency of Oral Intake after Esophagectomy: Who Needs Intense Nutritional Support after Esophagectomy?

Long-Term Insufficiency of Oral Intake after Esophagectomy: Who Needs Intense Nutritional Support after Esophagectomy?

Feasibility of enhanced recovery protocol in minimally invasive McKeown esophagectomy

Trimodal Therapy in Esophageal Squamous Cell Carcinoma: Role of Adjuvant Therapy Following Neoadjuvant Chemoradiation and Surgery

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