The effect of preoperative weight loss and body mass index on postoperative outcome in patients with esophagogastric carcinoma

Abstract

Studies have shown that weight loss is associated with adverse outcomes in all treatment modalities for esophagogastric carcinoma. Because of the increased prevalence of obesity and the effectiveness of perioperative nutrition, a number of patients are now obese or have normal body mass index (BMI) at the time of treatment. We investigated the relationship between weight loss, BMI, and outcome of surgery for patients with esophagogastric carcinoma. Data were collected over a 38-month period for all patients diagnosed with operable esophagogastric cancer at two UK centers. All patients underwent resection by a single Consultant Upper Gastrointestinal Surgeon and the use of perioperative jejunal feeding was universal. Ninety-three patients (57 male) underwent esophagogastric resection; 48 had no preoperative weight loss (34 with a BMI > 25 and 14 with a BMI < 25). Forty-five patients had preoperative weight loss (20 with BMI > 25 and 25 with BMI < 25). There was no significant difference in complication rates, median hospital stay, or mortality between the four groups. A significantly higher number of patients displaying preoperative weight loss were found to have stage III disease, but difference in survival of up to 3 years did not reach statistical significance on multivariate analysis. Preoperative weight loss and low BMI did not significantly influence the complication rate, perioperative mortality rate, length of hospital stay, or short-term prognosis. We conclude that preoperative weight loss can not be reliably used as an independent predictor of poor outcome in patients undergoing surgery for esophagogastric carcinoma. However, patients with preoperative weight loss and low BMI are more likely to have advanced disease.

The influence of high body mass index on the prognosis of patients with esophageal cancer after surgery as primary therapy

“…A few reports that specifically focused on BMI suggested that pretreatment BMI was not associated with differential outcome with regard to OS or DFS. [12][13][14] However, the largest study to date is by Trivers et al 17 18 demonstrated that a BMI of >18 kg/m 2 was one of the independent prognostic factors in 105 patients treated with definitive chemoradiotherapy (P ¼ .003). However, in this study, the cutpoint for BMI was nontraditional and the sample size was small.…”

“…8 High BMI is a risk factor for gastroesophageal reflux disease (GERD) and, consequently, for EAC. [9][10][11] Several studies have reported that high BMI was not associated with improved or reduced overall survival (OS) after esophagectomy, [12][13][14] although increased postoperative morbidity, such as respiratory complications, anastomotic leaks, and length of hospital stay, have been associated with high BMI in patients with gastroesophageal cancer who are undergoing surgery. 14,15 Many of these studies included small number of patients, in whom adjunctive therapy (preoperative chemotherapy and/or radiotherapy) was used.…”

Role of Nutritional Status in Predicting the Length of Stay in Cancer: A Systematic Review of the Epidemiological Literature

“…serum albumin, transferrin, and nitrogen balance studies; (iii) subjective global assessment (SGA) based on medical history and physical examination; patient-generated SGA (PG-SGA) adapted from the SGA specifically for cancer patients; (iv) the malnutrition screening tool (MST), considered the quickest and most simple tool for nutritional screening by the American Society for Parenteral and Enteral Nutrition (ASPEN); (v) Nutritional Risk Screening 2002 (NRS-2002), designed to detect malnutrition and the risk of developing malnutrition in the hospital setting as recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) [10], and (vi) the Malnutrition Universal Screening Tool (MUST), developed by the British Association for Parenteral and Enteral Nutrition, devised for application in all adult patients across all health care settings [1]. Many other nutritional parameters, including the Prognostic Nutritional Index, the Nutritional Risk Index, the Nutritional Screening Tool, the Maastricht Index, the Instant Nutrition Assessment, and the Mini Nutritional Assessment, have also been used to attempt to risk stratify patients [3,11,12]. The utility of these nutritional screening tools has been evaluated by their ability to predict relevant clinical outcomes, such as complications, treatment response, survival, hospital length of stay (LOS), and higher costs of health care [4,9,13].…”

Bispectral Index Monitoring, Duration of Bispectral Index Below 45, Patient Risk Factors, and Intermediate-term Mortality after Noncardiac Surgery in the B-Unaware Trial

“…Low body mass index and anemia, as in previous studies, are likely to reflect the presence of general poor health or a more advanced stage of preexisting malignancy status. 19 -22 Low body mass index has been described as a marker of patients who are more likely to have advanced disease including esophageal, 20 gastric, 21 and lung 22 cancers. Anemia has also been shown prospectively to be associated with increased risk for perioperative infection and adverse outcome in surgical patients.…”