Preoperative nutritional optimization of esophageal cancer patients

Abstract

Optimization of the nutritional and metabolic state prior to major surgery leads to improved surgical outcomes and is increasingly seen as an important part of oncology disease management. For locally advanced esophageal cancer the treatment is multimodal, including neoadjuvant chemoradiotherapy or perioperative chemotherapy in combination with esophageal resection. Patients undergoing such a multimodal treatment have a higher risk for progressive decline in their nutritional status. Preoperative malnutrition and loss of skeletal muscle mass has been reported to correlate with unfavorable outcomes in patients who undergo esophageal cancer surgery. Decline in nutritional status is most likely caused by insufficient nutritional intake, reduced physical activity, systemic inflammation and the effects of anticancer therapy. To ensure an optimal nutritional status prior to surgery, it is key to assess the nutritional status in all preoperative esophageal cancer patients, preferable early in the treatment trajectory, and to apply nutritional interventions accordingly. Nutritional management of esophageal cancer can be challenging, the optimal nutritional therapy is still under debate, and warrants more nutritional scientific research. In this review, the most recent findings regarding preoperative nutrition associated with outcomes in patients with esophageal cancer will be explored.

The impact of properly diagnosed sarcopenia on postoperative outcomes after gastrointestinal surgery: A systematic review and meta-analysis

“…In this sense, further studies that evaluate the impact of performing preoperative interventions (e.g. resistance exercise program, optimization of protein intake [56], vitamin D supplementation, among others) are necessary, potentially minimizing the incidence of adverse events and even postoperative mortality.…”

Novel technique to repair a bronchopleural fistula after esophagectomy using wide intercostal muscle flap fixed by azygos vein and bronchus: a case report

“…Additionally, in this case, sarcopenia existed as a characteristic of esophageal cancer itself and one of the complications associated with preoperative treatment [6,9]. Although pre-and postoperative nutritional care with parenteral and enteral nutrition was performed continuously, nutritional status hardly improved due to inflammation associated with cancer, thoracic infection, and multimodal treatment [9]. It was likely that the cause of BPF was not only intraoperative bronchial cauterization but also sarcopenia.…”

“…It has been reported that the rates of the post-esophagectomy complications of BPF and empyema are 0.3% and 2.3%, respectively [ 8 ]. Additionally, in this case, sarcopenia existed as a characteristic of esophageal cancer itself and one of the complications associated with preoperative treatment [ 6 , 9 ]. Although pre- and postoperative nutritional care with parenteral and enteral nutrition was performed continuously, nutritional status hardly improved due to inflammation associated with cancer, thoracic infection, and multimodal treatment [ 9 ].…”

The Influence of Pretherapeutic and Preoperative Sarcopenia on Short-Term Outcome after Esophagectomy

“…It has already been proven that prehabiliation and preoperative optimization of nutrition in cancer patients leads to better outcome and better quality of life after cancer surgery [ 45 , 46 ]. Nutrition goals include an adequate nutritional intake to prevent loss of muscle mass, modulate inflammation and the immune response, optimize glucose control, reduce the hypermetabolic response to surgery, and provide nutrients to optimize wound and anastomotic healing and recovery [ 18 , 19 , 20 , 47 , 48 , 49 , 50 ].…”