Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2019; 11(12): 1182-1192
Published online Dec 15, 2019. doi: 10.4251/wjgo.v11.i12.1182
Impact of regular enteral feeding via jejunostomy during neo-adjuvant chemotherapy on body composition in patients with oesophageal cancer
Imran M Mohamed, John Whiting, Benjamin HL Tan
Imran M Mohamed, John Whiting, Benjamin HL Tan, Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom
Author contributions: Mohamed IM, Whiting J and Tan BHL contributed to the completion of the manuscript; Mohamed IM contributed to manuscript writing and data analysis; Whiting J contributed to manuscript writing and review; Tan BHL contributed to conception and design, manuscript writing, data analysis and review; All authors have read and approved the final manuscript.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Benjamin HL Tan, MBChB, MD, FRCS, Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, United Kingdom. benjamin.tan@uhb.nhs.uk
Received: February 25, 2019
Peer-review started: February 26, 2019
First decision: July 31, 2019
Revised: August 29, 2019
Accepted: November 4, 2019
Article in press: November 4, 2019
Published online: December 15, 2019
Abstract
BACKGROUND

Malnourishment and sarcopenia are well documented phenomena in oesophageal cancer. Patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy have complex nutritional needs.

AIM

To examine the effect of regular nutritional support via feeding jejunostomy on overall body composition in patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy for oesophageal cancer.

METHODS

Retrospective data were collected for 15 patients before and after neo-adjuvant chemotherapy. All patients had feeding jejunostomies inserted at staging laparoscopy prior to neo-adjuvant chemotherapy and underwent regular jejunostomy feeding. Changes in body composition were determined by analysis of computed tomography imaging.

RESULTS

Patient age was 61.3 ± 12.8 years, and 73% of patients were male. The time between start of chemotherapy and surgery was 107 ± 21.6 d. There was no change in weight (74.5 ± 14.1 kg to 74.8 ± 13.1 kg) and body mass index (26.0 ± 3.8 kg/m2 to 26.1 ± 3.4 kg/m2). Body composition analysis revealed a statistically significant decrease in lumbar skeletal muscle index despite regular feeding (45.8 ± 8.0 cm2/m2 to 43.5 ± 7.3 cm2/m2; P = 0.045). The proportion of sarcopenic patients increased (33.3% to 60%). Six patients (40%) experienced dose-limiting toxicity during chemotherapy.

CONCLUSION

Regular jejunostomy feeding during neo-adjuvant chemotherapy can maintain weight and adipose tissue. Feeding alone is not sufficient to maintain muscle mass. Further insight into the underlying processes causing reduced muscle mass in cancer patients may help to provide targeted interventions.

Keywords: Body composition, Neo-adjuvant therapy, Oesophageal cancer, Enteral feeding

Core tip: Patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy have complex nutritional needs. Retrospective data were collected for 15 patients before and after neo-adjuvant chemotherapy to examine the effect of regular nutritional support via feeding jejunostomy on overall body composition. There was no change in weight and body mass index. Body composition analysis revealed a statistically significant decrease in lumbar skeletal muscle index despite regular feeding. Regular jejunostomy feeding during neo-adjuvant chemotherapy can maintain weight and adipose tissue. Further insight into processes causing reduced muscle mass in cancer patients may provide targeted interventions.