Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

Abstract

Over the past decades, survival rates for patients with resectable esophageal cancer have improved significantly. Consequently, the sequelae of having a gastric conduit, such as development of micronutrient deficiencies, become increasingly apparent. This study investigated postoperative micronutrient trends in the follow-up of patients following a minimally invasive esophagectomy (MIE) for cancer. Patients were included if they had at least one postoperative evaluation of iron, ferritin, vitamins B1, B6, B12, D, folate or methylmalonic acid. Data were available in 83 of 95 patients. Of these, 78.3% (65/83) had at least one and 37.3% (31/83) had more than one micronutrient deficiency at a median of 6.1 months (interquartile range (IQR) 5.4-7.5) of follow-up. Similar to the results found in previous studies, most common deficiencies identified were: iron, vitamin B12 and vitamin D. In addition, folate deficiency and anemia were detected in a substantial amount of patients in this cohort. At 24.8 months (IQR 19.4-33.1) of follow-up, micronutrient deficiencies were still common, however, most deficiencies normalized following supplementation on indication. In conclusion, patients undergoing a MIE are at risk of developing micronutrient deficiencies as early as 6 up to 24 months after surgery and should therefore be routinely checked and supplemented when needed.

Vitamin insufficiency after surgery for oesophagogastric neoplasms: a study protocol for a prospective intervention study

“…Oral supplementation is advised in the preoperative setting for both patients with EC and GC, while postoperative advice regarding monitoring of micronutrients and additional micronutrient supplementation for these patients is lacking 27. However, literature investigating malnutrition after oesophageal or gastric surgery shows that malnutrition and suboptimal micronutrient intake is highly prevalent 13–15. Moreover, current evidence shows that a thorough understanding of the postoperative micronutritional needs and treatment of micronutrient deficiencies for these patients is necessary 12 27 28…”

“…A few studies reported micronutrient and macronutrient deficiencies after both oesophagectomy for EC and gastrectomy for GC 13–15. Deficiencies were found in 60%–78% of the study population.…”

Nutritional care in patients undergoing laparoscopic/minimally invasive surgeries for gastrointestinal tumours

“…Deficiencies in micronutrients have been reported even after minimally invasive surgeries for digestive tumours [ 90 ]. Accordingly, immunonutrition has been reported with many clinical applications due to their favourable advantages and their role in patient outcomes ( Table II ) [ 91 – 93 ].…”

Ferroptosis and its Role in Gastric Cancer

“…In one study, iron oxidation has been shown to contribute to tumor formation and subsequent cancer development ( Torti and Torti, 2013 ). On the other hand, several studies reported that iron deficiency may enhance the risk of developing cancer ( Janssen et al, 2020 ). Anemia, low serum ferritin levels, and autoimmune gastritis–related iron malabsorption were identified as risk factors associated with gastrointestinal tumors and GC ( Nomura et al, 1992 ; Cover et al, 2013 ; Kamada et al, 2021 ).…”