Risk factors for loss of bone mineral density after curative esophagectomy

Elliott, Jessie A; Casey, Sarah; Murphy, Conor; Docherty, Neil G.; Ravi, Narayanasamy; Beddy, Peter; Reynolds, John V.; Roux, Carel W. le

doi:10.1007/s11657-018-0556-z

Cited by 12 publications

(13 citation statements)

References 47 publications

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“…Three studies were excluded because one study had an incorrect population [17], and the other two were incorrect exposures [18,19]. Three additional studies were excluded because missing data could not be obtained after asking the original authors [20][21][22]. After contacting the original authors, we included an additional study.…”

Section: Resultsmentioning

confidence: 99%

Prognostic value of preoperative low bone mineral density in patients with digestive cancers: a systematic review and meta-analysis

et al. 2022

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Purpose Osteopenia typically presents low bone mineral density (BMD) and has recently been reported as a prognostic factor in various cancers. However, the prognostic value of osteopenia in digestive tract cancers remains to be defined. We aimed to review the prognostic value of preoperative osteopenia in patients with digestive cancers. Methods Cohort studies evaluating the prognostic value of preoperative osteopenia in digestive cancers (colorectal, esophageal, hepatic, bile duct, and pancreatic cancer) were searched using electronic databases and trial registries. The exposure was defined as low BMD estimated by computed tomography at 11th thoracic vertebra, while comparator was normal BMD. The primary outcomes were overall survival and recurrence-free survival for osteopenia. Random effect meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence. Results A total of 11 studies (2230 patients) were included. Osteopenia was an independent risk factor for overall survival (hazard ratio [HR] = 2.02, 95% CI = 1.47 to 2.78; I2 = 74%), along with sarcopenia. Osteopenia also predicted poor recurrence-free survival (HR = 1.96, 95% CI = 1.36 to 2.81; I2 = 85%). In subgroup analyses, osteopenia predicted prognosis in colorectal, esophageal, hepatic, and bile duct cancers, but not in pancreatic cancer. The certainty of the evidence was low due to inconsistency and publication bias. Conclusion Osteopenia may be independently associated with poor prognosis in patients with digestive tract cancer. Further studies are needed to establish the relevance of osteopenia in the operative prognosis of these patients.

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Section: Resultsmentioning

confidence: 99%

Prognostic value of preoperative low bone mineral density in patients with digestive cancers: a systematic review and meta-analysis

et al. 2022

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“…Due to the anatomical changes to the upper gastrointestinal tract to replace the resected esophagus, adverse gastrointestinal symptoms, such as nausea, vomiting, regurgitation, diarrhea, dumping or loss of appetite and reduced intake are common. While these symptoms may also contribute to the development of micronutrient deficiencies, exact mechanisms involved in the development of micronutrient deficiencies following an esophagectomy, as well as the decrease in bone mineral density are still not fully understood and may well be dissimilar [13,15,25,27]. However, similarly to gastric surgery, it has been reported that pancreatic insufficiency also contributes to the postoperative morbidity in patients following an esophagectomy [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…The study (n = 75) by Elliott et al reported a substantial number of patients with a vitamin D deficiency both one and two years after surgery. However, it was also reported that serum vitamin D levels did not change significantly [27]. Despite no significant postoperative change in serum vitamin D, calcium or phosphate levels, it was reported that bone mineral density was significantly decreased at one year and two years after surgery, while osteoporosis was detected in 38% and 44% of patients, respectively.…”

Section: Descriptive Literature Reviewmentioning

confidence: 99%

Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

et al. 2020

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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.

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“…This study was approved by the regional research ethics committee (2017-07 (6)) and it was undertaken in accordance with the principles of ICH Good Clinical Practice with written, informed consent obtained from all participants. The study was prospectively registered on ClinicalTrials.gov (NCT03377660).…”

Section: Study Design and Protocolmentioning

confidence: 99%

“…Unintentional weight loss and gastrointestinal symptoms associated with malnutrition and impaired functional recovery are serious and common concerns for patients after esophagectomy, even among those who remain free from recurrent disease in the long-term (1)(2)(3)(4). In addition to weight loss, malnourished patients may have sarcopenia and osteopenia (5)(6)(7). These issues accentuate the psychosocial burden experienced by patients post esophagectomy, impairing physical function and long-term health-related quality of life (HRQL) (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of Gut-Brain Signaling After Octreotide Therapy for Unintentional Weight Loss After Esophagectomy

Murphy

Stratford

Docherty

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Background Recurrence-free patients after esophageal cancer surgery face long-term nutritional consequences, occurring in the context of an exaggerated postprandial gut hormone response. Acute gut hormone suppression influences brain reward signaling and eating behavior. This study aimed to suppress gut hormone secretion and characterize reward responses and eating behavior among postesophagectomy patients with unintentional weight loss. Methods This pilot study prospectively studied postoperative patients with 10% or greater body weight loss (BWL) beyond 1 year who were candidates for clinical treatment with long-acting octreotide (LAR). Before and after 4 weeks of treatment, gut hormone secretion, food cue reactivity (functional magnetic resonance imaging), eating motivation (progressive ratio task), ad libitum food intake, body composition, and symptom burden were assessed. Results Eight patients (7 male, age: mean ± SD 62.8 ± 9.4 years, postoperative BWL: 15.5 ± 5.8%) participated. Octreotide LAR did not significantly suppress total postprandial plasma glucagon-like peptide-1 response at 4 weeks (P = .08). Postprandial symptom burden improved after treatment (Sigstad score median [range]: 12 [2-28] vs 8 [3-18], P = .04) but weight remained stable (pre: 68.6 ± 12.8 kg vs post: 69.2 ± 13.4 kg, P = .13). There was no significant change in brain reward system responses, during evaluation of high-energy or low-energy food pictures, nor their appeal rating. Moreover, treatment did not alter motivation to eat (P = .41) nor ad libitum food intake(P = .46). Conclusion The protocol used made it feasible to characterize the gut-brain axis and eating behavior in this cohort. Inadequate suppression of gut hormone responses 4 weeks after octreotide LAR administration may explain the lack of gut-brain pathway alterations. A higher dose or shorter interdose interval may be required to optimize the intervention.

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Risk factors for loss of bone mineral density after curative esophagectomy

Cited by 12 publications

References 47 publications

Prognostic value of preoperative low bone mineral density in patients with digestive cancers: a systematic review and meta-analysis

Prognostic value of preoperative low bone mineral density in patients with digestive cancers: a systematic review and meta-analysis

Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

A Pilot Study of Gut-Brain Signaling After Octreotide Therapy for Unintentional Weight Loss After Esophagectomy

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