Nutritional management during neoadjuvant therapy for esophageal cancer

Bower, Matthew; Martin, Robert C.G.

doi:10.1002/jso.21289

Cited by 78 publications

(48 citation statements)

References 74 publications

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“…preoperatively [13], while 90% of patients had a 5% weight loss at 3 months postoperatively [14]. It is noteworthy that in many patients weight loss persists for at least 3 years after surgical intervention [15].…”

Section: Introductionmentioning

confidence: 99%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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Esophageal cancer is associated with malnutrition in the vast majority of patients. This phenomenon is partly attributed to the disease process itself, the location of the tumor and other factors, such as dysphagia which is often accentuated due to chemotherapy/ radiotherapy treatment or surgical intervention. The poor nutritional status of these patients is often related to the presence of cancer cachexia, altered metabolism, and tissue wasting. Malnutrition in this patient population affects quality of life, worsens patient's tolerance to chemotherapy and accounts for lower survival. Nutritional management of these patients includes both proper nutritional assessment and support and might prevent, to a certain extent, the manifestation of malnutrition-related consequences. The purpose of this article is to review the current literature in order to focus on the etiology and diagnosis of malnutrition in esophageal cancer patients, emphasizing also on the optimal nutritional support during multimodality treatment.

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Section: Introductionmentioning

confidence: 99%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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“…These patients represent an extraordinary therapeutic challenge, because they are not only malnourished due to the advanced disease, but during preoperative therapy, nutritional status often deteriorates because the esophageal passage continues to be occluded and perioperative therapy even worsens the patient's general constitution due to chemotherapeutic side effects on the gastrointestinal tract and the immune system. Not only chemotherapy-associated nausea and vomiting, diarrhea, dryness of mouth, different perception of taste and smell, but also psychosomatic factors related to disease coping may all contribute to a reduced intake of nutrients [15]. Further, increased chemotherapy-associated toxicity was described in malnourished patients due to reduced concentrations of plasma proteins [16].…”

Section: The Medical Problemmentioning

confidence: 99%

Feeding Challenges in Patients with Esophageal and Gastroesophageal Cancers

Reim

Frieß

2015

Gastrointest Tumors

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Background: Patients undergoing treatment for esophagogastric or esophageal cancer are exposed to a considerably high risk of malnutrition due to early obstruction of the gastrointestinal passage. Presently most of the patients undergo modern multimodal therapies which require chemoradiation or chemotherapy ahead of surgery. Therefore reconstruction of the obstructed gastrointestinal passage is considerably delayed. Surgery as the only curative option after neoadjuvant treatment is the mainstay of therapy in this setting. However, many patients are at risk for the development of postoperative complications associated with the complexity of the surgical procedure. Therefore enteral feeding as a prerequisite to avoid malnutrition represents a special therapeutic challenge. Summary: This review describes the recent literature on the incidence and influence of perioperative malnutrition on oncologic outcome, measures to determine patients at risk, possible strategies to reduce or avoid malnutrition by supportive enteral/parenteral nutrition, implementation of the enhanced recovery after surgery programs and feeding routes, but also surgical and adjuvant procedures in the curative and palliative setting for patients undergoing treatment for gastroesophageal cancers. Key Messages: Appropriate identification of patients at risk is crucial to avoid malnutrition. Early nutritional interventions during multimodal/neoadjuvant treatment may be beneficial for weight loss reduction although the evidence is not conclusive. Pouch reconstructions during surgery should be applied in order to increase quality of life and eating capacity. Reduction of postoperative complications could provide potential benefits. In palliative patients, insertion of self-expanding metal stents can reduce dysphagia and improve quality of life, but does not prolong overall survival. Further evidence is required to determine the value of the procedures and measures described in this review. Practical Implications: Nutritional risk scoring should be performed for every gastroesophageal cancer patient. Sophisticated reconstruction methods and early recovery programs should be enforced to reduce perioperative starvation periods. Self-expanding metal stents should be used for palliative patients.

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“…Physical exam fi ndings suggestive of malnutrition include loss of subcutaneous fat, muscle wasting, edema, and ascites as signs of protein calorie malnutrition (see Table 5.3 ). Laboratory evaluations include assessments of rapid turnover proteins including albumin (halflife 20 days), prealbumin (half-life 2-3 days), and transferrin (half-life 8-10 days) [ 43 ].…”

Section: Nutritional Assessment and Optimizationmentioning

confidence: 99%