Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy

Jain, Rishi; Shaikh, Talha; Yee, Jia-Llon; Au, Cherry; Denlinger, Crystal S.; Handorf, Elizabeth; Meyer, Joshua E.; Dotan, Efrat

doi:10.3390/nu12103177

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…However, although weight loss frequently occurs during the NAT period (i.e. after diagnosis to surgery) in esophageal cancer patients 10 , 11 , its impact on short-term outcomes after esophagectomy remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal cancer has the highest median weight loss before diagnosis among all cancers 7 . Nearly half of the patients undergoing esophagectomy experience weight loss before diagnosis 8 , 9 and further weight loss occurs frequently during neoadjuvant therapy (NAT) 10 , 11 , which has become common worldwide recently for advanced esophageal cancer 12 . The cause of weight loss is multifactorial, including tumor-associated symptoms (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Weight loss during neoadjuvant therapy and short-term outcomes after esophagectomy: a retrospective cohort study

Hirano

Konishi

Kaneko

et al. 2023

International Journal of Surgery

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Background: Neoadjuvant therapy (NAT) has become common worldwide for resectable advanced esophageal cancer and frequently involves weight loss. Although failure to rescue (death after major complications) is known as an emerging surgical quality measure, little is known about the impact of weight loss during NAT on failure to rescue. This retrospective study aimed to investigate the association of weight loss during NAT and short-term outcomes, including failure to rescue after esophagectomy. Materials and methods: Patients who underwent esophagectomy after NAT between July 2010 and March 2019 were identified from a Japanese nationwide inpatient database. Based on quartiles of percent weight change during NAT, patients were grouped into four categories of gain, stable, small loss, and loss (>4.5%). The primary outcomes were failure to rescue and in-hospital mortality. The secondary outcomes were major complications, respiratory complications, anastomotic leakage, and total hospitalization costs. Multivariable regression analyses were used to compare outcomes between the groups, adjusting for potential confounders, including baseline BMI. Results: Among 15 159 eligible patients, in-hospital mortality and failure to rescue occurred in 302 (2.0%) and 302/5698 (5.3%) patients, respectively. Weight loss (>4.5%) compared to gain was associated with increased failure to rescue and in-hospital mortality [odds ratios 1.55 (95% CI: 1.10–2.20) and 1.53 (1.10–2.12), respectively]. Weight loss was also associated with increased total hospitalizations costs, but not with major complications, respiratory complications, and anastomotic leakage. In subgroup analyses, regardless of baseline BMI, weight loss (>4.8% in nonunderweight or >3.1% in underweight) was a risk factor for failure to rescue and in-hospital mortality. Conclusion: Weight loss during NAT was associated with failure to rescue and in-hospital mortality after esophagectomy, independent of baseline BMI. This emphasizes the importance of weight loss measurement during NAT to assess the risk for a subsequent esophagectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Weight loss during neoadjuvant therapy and short-term outcomes after esophagectomy: a retrospective cohort study

Hirano

Konishi

Kaneko

et al. 2023

International Journal of Surgery

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“…The NRS2002 score is a simple and practical predictor of clinical outcomes and is recommended as a nutritional risk screening tool for EC patients [ 16 , 17 ]. The PG-SGA was first proposed by American scholar Ottery in 1994 and was developed based on subjective global assessment (SGA) [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Nasogastric tube feeding improves nutritional status and physical state in esophageal cancer patients during chemoradiotherapy: a retrospective study

Shuan

Dai

Zhu³

et al. 2023

Support Care Cancer

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Objective To compare the complication rates, nutritional status, and physical state between esophageal cancer (EC) patients managed by nasogastric tube (NGT) feeding versus those managed by oral nutritional supplementation (ONS) during chemoradiotherapy. Methods EC patients undergoing chemoradiotherapy managed by nonintravenous nutritional support in our institute were retrospectively recruited and divided into an NGT group and an ONS group based on the nutritional support method. The main outcomes, including complications, nutritional status, and physical state, were compared between groups. Results The baseline characteristics of EC patients were comparable. There were no significant differences in the incidence of treatment interruption (13.04% vs. 14.71%, P = 0.82), death (2.17% vs. 0.00%, P = 0.84), or esophageal fistula (2.17% vs. 1.47%, P = 1.00) between the NGT group and ONS group. Body weight loss and decrease in albumin level were significantly lower in the NGT group than in the ONS group (both P < 0.05). EC patients in the NGT group had significantly lower Nutritional Risk Screening 2002 (NRS2002) and Patient-Generated Subjective Global Assessment (PG-SGA) scores and significantly higher Karnofsky Performance Status (KPS) scores than patients in the ONS group (all P < 0.05). The rates of grade > 2 esophagitis (10.00% vs. 27.59%, P = 0.03) and grade > 2 bone marrow suppression (10.00% vs. 32.76%, P = 0.01) were significantly lower in the NGT group than in the ONS group. There were no significant differences in the incidence of infection and upper gastrointestinal disorders or therapeutic efficacy between groups (all P > 0.05). Conclusions EN through NGT feeding leads to significantly better nutritional status and physical state in EC patients during chemoradiotherapy than EN via ONS. NGT may also prevent myelosuppression and esophagitis..

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“…Especially at the time of preoperative chemotherapy and radiotherapy sessions. [7,8] In clinical observation of patients after jejunostomy, the presence of dumping syndrome was observed, due to the faster speed at which the food enters the intestine through the jejunostomy tube. [9] The prevalence of dumping syndrome is considered high among esophagus cancer patients, with a prevalence ranging between 20-50% of the patients.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture effect on dumping syndrome in esophagus cancer patients with feeding jejunostomy: A study protocol for a single blind randomized control trial

et al. 2023

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Introduction: Esophagus cancer patients are at risk for malnourishment. Feeding jejunostomy is used in advanced esophagus cancer patients in order to support and supplement the patients’ nutrition needs. In dumping syndrome, the food is rapidly introduced into the intestine at a rate that is faster than normal, it is associated with both digestive system and vasoactive symptoms. Dumping syndrome has an association with both esophagus cancer patients and feeding jejunostomy. In the mid and long term, dumping syndrome is an important issue that contributes to the risk of malnourishment in advanced esophagus cancer patients. In recent studies, acupuncture was effective in regulating digestive symptoms. Acupuncture is considered to be a safe intervention, that was previously shown to be effective in treating digestive-related symptoms. Methods: Sixty advanced esophageal cancer patients post-feeding jejunostomy will be divided into 2 equal groups, an intervention group (n = 30) and a control group (n = 30). Patients in the intervention group will receive acupuncture using the following acupoints: ST36 (Zusanli), ST37 (Shangjuxu), ST39 (Xiajuxu), PC6 (Neiguan), LI4 (Hegu), and Liv 3 (Taichung). Patients in the control group will receive shallow acupuncture on 12 non-acupoints (sham points), 1 cm from the above mention points. Patients and assessors will be blind to trial allocation. Both groups will receive acupuncture twice a week for 6 weeks. The main outcome measurements are: body weight, BMI, Sigstad’s score, and the Arts’ dumping questionnaire. Discussion: There are no previous studies that have examined the use of acupuncture on patients with dumping syndrome. This single-blind randomized control trial will investigate the effect of acupuncture on dumping syndrome in advanced esophagus cancer patients with feeding jejunostomy. The results will determine if verum acupuncture can affect dumping syndrome and prevent weight loss.

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Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy

Cited by 6 publications

References 26 publications

Weight loss during neoadjuvant therapy and short-term outcomes after esophagectomy: a retrospective cohort study

Weight loss during neoadjuvant therapy and short-term outcomes after esophagectomy: a retrospective cohort study

Nasogastric tube feeding improves nutritional status and physical state in esophageal cancer patients during chemoradiotherapy: a retrospective study

Acupuncture effect on dumping syndrome in esophagus cancer patients with feeding jejunostomy: A study protocol for a single blind randomized control trial

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