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Published in: Esophagus 4/2017

01-10-2017 | Original Article

Nutritional changes and factors contributing to postoperative weight recovery after esophagectomy

Authors: Genya Okada, Yoshinari Matsumoto, Yoshihiro Nakamura, Fumikazu Hayashi, Kumiko Kato, Chika Momoki, Yoko Yasui, Daiki Habu, Eijiro Edagawa, Yasunori Matsuda, Satoru Kishida, Shigeru Lee, Harushi Osugi

Published in: Esophagus | Issue 4/2017

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Abstract

Background

In patients treated surgically for esophageal cancer, time-dependent data on nutritional status from the perioperative to postoperative period are questionable. We investigated time-dependent data on weight, body composition, and nutritional indices of patients with esophageal cancer from the preoperative period through the 12-month postoperative period.

Methods

Eighty patients with esophageal cancer were enrolled and subsequently underwent esophagectomy. Forty out of eighty patients were completed the 12-month follow-up survey period and analyzed. We assessed clinical, anthropometric measurement, laboratory data, and nutritional status data preoperatively and at 1, 3, 6, and 12 months postoperatively.

Results

Patients with esophageal cancer had 7.2% weight loss in the preoperative period compared with the usual body weight (UBW) before morbidity and 9.3% weight loss from preoperative to 12-month postoperative period. Weight gain in the postoperative survey period was not significant. Conversely, there was a time lag in the time-dependent changes in the postoperative nutritional status; this was considered to coincide with internal organ protein, body protein, and body fat levels, in that order. Multivariate analysis identified a ≥ 10% preoperative weight loss compared with UBW as the only independent factor negatively contributing to ≥ 85% weight recovery at 12 months postoperatively (OR 6.54, 95% CI 1.14–37.60, p = 0.036).

Conclusions

For sufficient nutritional status recovery in patients treated with esophagectomy, minimizing weight loss preoperatively is important. Regardless of neoadjuvant therapy or age, preoperative nutritional treatment should be promptly administered for all patients.
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Literature
2.
go back to reference Pedersen H, Hansen HS, Cederqvist C, et al. The prognostic significance of weight loss and its integration in stage-grouping of oesophageal cancer. Acta Chir Scand. 1982;148:363–6.PubMed Pedersen H, Hansen HS, Cederqvist C, et al. The prognostic significance of weight loss and its integration in stage-grouping of oesophageal cancer. Acta Chir Scand. 1982;148:363–6.PubMed
3.
go back to reference Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. J Japan Surg Soc. 1984;85:1001–5. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. J Japan Surg Soc. 1984;85:1001–5.
4.
go back to reference O’Gorman P, McMillan DC, McArdle CS. Longitudinal study of weight, appetite, performance status, and inflammation in advanced gastrointestinal cancer. Nutr Cancer. 1999;35:127–9.CrossRefPubMed O’Gorman P, McMillan DC, McArdle CS. Longitudinal study of weight, appetite, performance status, and inflammation in advanced gastrointestinal cancer. Nutr Cancer. 1999;35:127–9.CrossRefPubMed
5.
go back to reference Guo SZ, Shen Q, Zhang HB. Expression and significance of immunosuppressive acidic protein (IAP) in human esophageal squamous cell carcinoma. Zhonghua Zhong Liu Za Zhi. 1994;16:125–7.PubMed Guo SZ, Shen Q, Zhang HB. Expression and significance of immunosuppressive acidic protein (IAP) in human esophageal squamous cell carcinoma. Zhonghua Zhong Liu Za Zhi. 1994;16:125–7.PubMed
6.
go back to reference Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.CrossRefPubMed Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.CrossRefPubMed
7.
go back to reference Herskovic A, Martz K, Al-Sarraf M, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992;326:1593–8.CrossRefPubMed Herskovic A, Martz K, Al-Sarraf M, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992;326:1593–8.CrossRefPubMed
8.
go back to reference Ettinger DS. Preventing chemotherapy-induced nausea and vomiting: an update and a review of emesis. Semin Oncol. 1995;22:6–18.PubMed Ettinger DS. Preventing chemotherapy-induced nausea and vomiting: an update and a review of emesis. Semin Oncol. 1995;22:6–18.PubMed
9.
go back to reference Martin L, Lagergren P. Long-term weight change after oesophageal cancer surgery. Br J Surg. 2009;96:1308–14.CrossRefPubMed Martin L, Lagergren P. Long-term weight change after oesophageal cancer surgery. Br J Surg. 2009;96:1308–14.CrossRefPubMed
10.
go back to reference Ouattara M, D’Journo XB, Loundou A, et al. Body mass index kinetics and risk factors of malnutrition one year after radical esophagectomy for cancer. Eur J Cardiothorac Surg. 2012;41:1088–93.CrossRefPubMed Ouattara M, D’Journo XB, Loundou A, et al. Body mass index kinetics and risk factors of malnutrition one year after radical esophagectomy for cancer. Eur J Cardiothorac Surg. 2012;41:1088–93.CrossRefPubMed
11.
go back to reference Carey S, Storey D, Biankin AV, et al. Long term nutritional status and quality of life following major upper gastrointestinal surgery—a cross-sectional study. Clin Nutr. 2011;30:774–9.CrossRefPubMed Carey S, Storey D, Biankin AV, et al. Long term nutritional status and quality of life following major upper gastrointestinal surgery—a cross-sectional study. Clin Nutr. 2011;30:774–9.CrossRefPubMed
12.
go back to reference Shafer KJ, Siders WA, Johnson LK, et al. Validity of segmental multiple-frequency bioelectrical impedance analysis to estimate body composition of adults across a range of body mass indexes. Nutrition. 2009;25:25–32.CrossRefPubMed Shafer KJ, Siders WA, Johnson LK, et al. Validity of segmental multiple-frequency bioelectrical impedance analysis to estimate body composition of adults across a range of body mass indexes. Nutrition. 2009;25:25–32.CrossRefPubMed
13.
go back to reference Sato M. Nutritional assessment of gastric cancer patients: estimation of risk of postoperative complication from preoperative nutritional states. J Japan Surg Soc. 1982;83:66–77. Sato M. Nutritional assessment of gastric cancer patients: estimation of risk of postoperative complication from preoperative nutritional states. J Japan Surg Soc. 1982;83:66–77.
14.
go back to reference Ignacio De Ulíbarri J, González-Madroño A, De Villar NGP, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20:38–45.PubMed Ignacio De Ulíbarri J, González-Madroño A, De Villar NGP, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20:38–45.PubMed
15.
go back to reference Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56:779–85.CrossRefPubMed Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56:779–85.CrossRefPubMed
16.
go back to reference Koizumi M, Hosoya Y, Dezaki K, et al. Postoperative weight loss does not resolve after esophagectomy despite normal serum ghrelin levels. Ann Thorac Surg. 2011;91:1032–7.CrossRefPubMed Koizumi M, Hosoya Y, Dezaki K, et al. Postoperative weight loss does not resolve after esophagectomy despite normal serum ghrelin levels. Ann Thorac Surg. 2011;91:1032–7.CrossRefPubMed
17.
go back to reference Morgan DB, Paterson CR, Woods CG, et al. Search for osteomalacia in 1228 patients after gastrectomy and other operations on the stomach. Lancet. 1965;2:1085–8.CrossRefPubMed Morgan DB, Paterson CR, Woods CG, et al. Search for osteomalacia in 1228 patients after gastrectomy and other operations on the stomach. Lancet. 1965;2:1085–8.CrossRefPubMed
19.
go back to reference Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491–7.CrossRefPubMed Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491–7.CrossRefPubMed
20.
go back to reference Moore FD. Metabolic care of the surgical patient. Philadelphia: WB Saunders Co; 1959. p. 421–2. Moore FD. Metabolic care of the surgical patient. Philadelphia: WB Saunders Co; 1959. p. 421–2.
21.
go back to reference Chapman KM, Nelson RA. Loss of appetite: managing unwanted weight loss in the older patient. Geriatrics. 1994;49:54–9.PubMed Chapman KM, Nelson RA. Loss of appetite: managing unwanted weight loss in the older patient. Geriatrics. 1994;49:54–9.PubMed
22.
go back to reference Okada G, Momoki C, Matsumoto Y, et al. The effects of preoperative weight loss on nutritional status and prognosis for esophageal cancer. J Gastroenterol Hepatol. 2016;3:026. Okada G, Momoki C, Matsumoto Y, et al. The effects of preoperative weight loss on nutritional status and prognosis for esophageal cancer. J Gastroenterol Hepatol. 2016;3:026.
23.
go back to reference Ryan C, Bryant E, Eleazer P, et al. Unintentional weight loss in long-term care: predictor of mortality in the elderly. South Med J. 1995;88:721–4.CrossRefPubMed Ryan C, Bryant E, Eleazer P, et al. Unintentional weight loss in long-term care: predictor of mortality in the elderly. South Med J. 1995;88:721–4.CrossRefPubMed
24.
25.
go back to reference Ejaz A, Spolverato G, Kim Y, et al. Impact of body mass index on perioperative outcomes and survival after resection for gastric cancer. J Surg Res. 2015;195:74–82.CrossRefPubMed Ejaz A, Spolverato G, Kim Y, et al. Impact of body mass index on perioperative outcomes and survival after resection for gastric cancer. J Surg Res. 2015;195:74–82.CrossRefPubMed
26.
go back to reference Martin L, Lagergren P. Risk factors for weight loss among patients surviving 5 years after esophageal cancer surgery. Ann Surg Oncol. 2015;22:610–6.CrossRefPubMed Martin L, Lagergren P. Risk factors for weight loss among patients surviving 5 years after esophageal cancer surgery. Ann Surg Oncol. 2015;22:610–6.CrossRefPubMed
27.
go back to reference D’Journo XB, Ouattara M, Loundou A, et al. Prognostic impact of weight loss in 1-year survivors after transthoracic esophagectomy for cancer. Dis Esophagus. 2012;25:527–34.CrossRefPubMed D’Journo XB, Ouattara M, Loundou A, et al. Prognostic impact of weight loss in 1-year survivors after transthoracic esophagectomy for cancer. Dis Esophagus. 2012;25:527–34.CrossRefPubMed
28.
go back to reference Ottery FD. Supportive nutrition to prevent cachexia and improve quality of life. Semin Oncol. 1995;22:98–111.PubMed Ottery FD. Supportive nutrition to prevent cachexia and improve quality of life. Semin Oncol. 1995;22:98–111.PubMed
Metadata
Title
Nutritional changes and factors contributing to postoperative weight recovery after esophagectomy
Authors
Genya Okada
Yoshinari Matsumoto
Yoshihiro Nakamura
Fumikazu Hayashi
Kumiko Kato
Chika Momoki
Yoko Yasui
Daiki Habu
Eijiro Edagawa
Yasunori Matsuda
Satoru Kishida
Shigeru Lee
Harushi Osugi
Publication date
01-10-2017
Publisher
Springer Japan
Published in
Esophagus / Issue 4/2017
Print ISSN: 1612-9059
Electronic ISSN: 1612-9067
DOI
https://doi.org/10.1007/s10388-017-0584-6

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