|
1
|
Boyle E, Elliott JA. Novel nutrition strategies in gastric and esophageal cancer. Expert Rev Gastroenterol Hepatol 2025; 19:89-104. [PMID: 39864091 DOI: 10.1080/17474124.2025.2457444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 12/16/2024] [Accepted: 01/20/2025] [Indexed: 01/28/2025]
Abstract
INTRODUCTION Advances in treatment strategies for gastric and esophageal cancer have led to improved long-term outcomes, however the local and systemic effects of the primary tumor, neoadjuvant therapies and surgery, result in specific nutritional challenges. Comprehensive nutritional evaluation and support represents a core component of multidisciplinary holistic care for this patient population. AREAS COVERED We provide a detailed overview of nutritional challenges in gastric and esophageal cancer, with a focus on malignant obstruction, preoperative optimization and survivorship. We discuss current management strategies and evidence base, and describe future therapeutic targets. EXPERT OPINION Data to support the optimal management of malignant dysphagia and obstruction, particularly regarding patient reported outcomes, is currently lacking. The advantages of nutritional optimization in the pre- and immediate postoperative phase are well described, but further research is needed to inform optimal personalised strategies. Emerging data regarding the physiologic regulation of appetite and body weight have provided key insights and informed the development of novel therapeutic targets to improve nutritional status among patients undergoing treatment for oesophageal and gastric cancer.
Collapse
Affiliation(s)
- Ellen Boyle
- Department of Surgery, Trinity St. James's Cancer Institute, Dublin, Ireland
| | - Jessie A Elliott
- Department of Surgery, Trinity St. James's Cancer Institute, Dublin, Ireland
| |
Collapse
|
|
2
|
Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
| |
Collapse
|
|
3
|
Elliott JA, Guinan E, Reynolds JV. Measurement and optimization of perioperative risk among patients undergoing surgery for esophageal cancer. Dis Esophagus 2024; 37:doad062. [PMID: 37899136 PMCID: PMC10906714 DOI: 10.1093/dote/doad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/28/2023] [Indexed: 10/31/2023]
Abstract
Esophagectomy is an exemplar of complex oncological surgery and is associated with a relatively high risk of major morbidity and mortality. In the modern era, where specific complications are targeted in prevention and treatment pathways, and where the principles of enhanced recovery after surgery are espoused, optimum outcomes are targeted via a number of approaches. These include comprehensive clinical and physiological risk assessment, specialist perioperative care by a high-volume team, and multimodal inputs throughout the patient journey that aim to preserve or restore nutritional deficits, muscle mass and function.
Collapse
Affiliation(s)
- Jessie A Elliott
- Trinity St. James’s Cancer Institute, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
| | - Emer Guinan
- Trinity St. James’s Cancer Institute, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
| | - John V Reynolds
- Trinity St. James’s Cancer Institute, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
| |
Collapse
|
|
4
|
Haneda R, Hiramatsu Y, Kawata S, Soneda W, Booka E, Murakami T, Matsumoto T, Morita Y, Kikuchi H, Takeuchi H. Clinical impact of diarrhea during enteral feeding after esophagectomy. Int J Clin Oncol 2024; 29:36-46. [PMID: 37994975 PMCID: PMC10764458 DOI: 10.1007/s10147-023-02428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 10/09/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Enteral feeding (EF) is recommended to enhance nutritional status after esophagectomy; however, diarrhea is a common complication of EF. We investigated the clinical and prognostic impact of diarrhea during EF after esophagectomy. METHODS One hundred and fifty-two patients who underwent transthoracic esophagectomy were enrolled. The King's stool chart was used for stool characterization. The short- and long-term outcomes were compared between a non-diarrhea (Group N) and diarrhea group (Group D). RESULTS A higher dysphagia score (≥ 1) was observed more frequently in Group D than in Group N (45.7% vs. 19.8%, p = 0.002). Deterioration of serum total protein, serum albumin, serum cholinesterase, and the prognostic nutritional index after esophagectomy was greater in Group D than in Group N (p = 0.003, 0.004, 0.014, and 0.001, respectively). Patients in Group D had significantly worse overall survival (OS) and recurrence-free survival (RFS) than those in Group N (median survival time (MST): OS, 21.9 vs. 30.6 months, p = 0.001; RFS, 12.4 vs. 27.7 months, p < 0.001). In stratified analysis due to age, although there was no difference in OS with or without diarrhea in young patients (MST: 24.1 months in a diarrhea group vs. 33.6 months in a non-diarrhea group, p = 0.218), patients in a diarrhea group had significantly worse OS than those in a non-diarrhea group in elderly patients (MST: 17.8 months vs. 27.9 months, p < 0.001). CONCLUSIONS Diarrhea during EF can put elderly patients at risk of postoperative malnutrition and a poor prognosis after esophagectomy.
Collapse
Affiliation(s)
- Ryoma Haneda
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
- Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Sanshiro Kawata
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Wataru Soneda
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomohiro Murakami
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomohiro Matsumoto
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| |
Collapse
|
|
5
|
Antasouras G, Papadopoulou SK, Tolia M, Pandi AL, Spanoudaki M, Tsoukalas N, Tsourouflis G, Psara E, Mentzelou M, Giaginis C. May Nutritional Status Positively Affect Disease Progression and Prognosis in Patients with Esophageal and Pharyngeal Cancers? A Scoping Review of the Current Clinical Studies. Med Sci (Basel) 2023; 11:64. [PMID: 37873749 PMCID: PMC10594480 DOI: 10.3390/medsci11040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Malnutrition in esophageal and pharyngeal cancer patients constitutes a common and serious concern, which significantly reduces patients' prognoses. Cancers of the esophagus and the pharynx can considerably impair feeding in patients, resulting in severe undernutrition. This is a scoping review that intends to critically analyze the most well-designed clinical studies investigating the potential beneficial impact of diverse nutritional assessment tools on the prognosis of patients with esophageal and pharyngeal cancers. METHODS The most accurate and remarkable scientific databases were comprehensively explored utilizing relative keywords to detect clinical studies that investigate whether nutritional status may affect disease prognosis. RESULTS Several assessment tools have evaluated and highlighted the potential beneficial impact of nutritional status on disease progression and patients' prognosis in both esophageal and pharyngeal cancers. Regarding esophageal cancer, CONUT, PNI, PG-SGA, and NRS-2002 are more commonly used, while albumin is also frequently evaluated. Regarding pharyngeal cancers, fewer studies are currently available. PNI has been evaluated, and its significance as a factor for shorter survival' times has been highlighted. The Comprehensive Nutritional Index has also been evaluated with positive results, as well as NRS 2002, GPS, and body-weight status. However, there is currently a lack of studies with an adequate number of women with cancer. An international literature gap was identified concerning follow-up studies with adequate methodology. CONCLUSIONS Nutritional status may significantly affect disease progression and patients' survival, highlighting the significance of a great nutritional status in individuals with esophageal and pharyngeal cancers. Further large-scale and well-designed prospective surveys should be performed to verify the potential beneficial effects of adequate nourishment in people suffering from cancer of the esophagus and pharynx.
Collapse
Affiliation(s)
- Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Maria Tolia
- Department of Radiotherapy, Faculty of Medicine, School of Health Sciences, University of Crete, 71110 Heraklion, Crete, Greece;
| | - Aimilia-Lynn Pandi
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Nikolaos Tsoukalas
- Department of Oncology, 401 General Army Hospital of Athens (401 Geniko Stratiotiko Nosokomeio Athenon), 11525 Athens, Greece;
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece;
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| |
Collapse
|
|
6
|
S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e209-e307. [PMID: 37285869 DOI: 10.1055/a-1771-6953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
|
7
|
Takebayashi K, Kaida S, Yamaguchi T, Otake R, Miyake T, Kojima M, Iida H, Maehira H, Mori H, Bamba S, Shimizu T, Sasaki M, Tani M. Clinical effect of home enteral tube feeding supplementation on nutritional status after esophagectomy with retrosternal gastric tube reconstruction. Dis Esophagus 2023; 36:6658240. [PMID: 35938861 DOI: 10.1093/dote/doac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/25/2022] [Indexed: 12/11/2022]
Abstract
Body weight loss and poor nutritional status are frequently observed after esophageal cancer surgery. The aim of this study was to pilot an investigation on the impact of home enteral tube feeding supplementation (HES) for up to 3 months after esophageal cancer surgery. We retrospectively reviewed consecutive 67 esophageal cancer patients who underwent esophagectomy with gastric tube reconstruction. We started HES from April 2017. The patients were divided into 2 groups. Among 67 patients, 40 patients underwent HES between April 2017 and November 2020 (HES group). Other 27 patients who underwent esophagectomy between January 2012 and March 2017 were not administered HES (C group). Thereafter, multiple factors concerning patient nutritional status at long-term follow-up were evaluated. The baseline characteristics were balanced between the two groups. There were no significant differences in nutritional status scores before esophagectomy. The percentage weight loss was less in the HES group compared with the C group both at 3 months and 1 year after surgery: 7.3% (-7.6 to 15.2), 7.7% (-4 to 13.9) in the HES group and 10.6% (-3.6 to 29.1), 10.8% (-5.8 to 20.0) in C group (P < 0.05, P < 0.05). In the patients with anastomotic stenosis, the percentage weight loss was less in the HES group compared with the C group: 7.2% (2.0-14.9) and 14.6% (6.2-29.1), P < 0.05. HES may improve early weight loss in postesophagectomy patients.
Collapse
Affiliation(s)
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Reiko Otake
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masatsugu Kojima
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shigeki Bamba
- Division of Clinical Nutrition, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Tomoharu Shimizu
- Medical Safety Section, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Masaya Sasaki
- Division of Clinical Nutrition, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| |
Collapse
|
|
8
|
Hayes M, Gillman A, Wright B, Dorgan S, Brennan I, Walshe M, Donohoe C, Reynolds JV, Regan J. Prevalence, nature and trajectory of dysphagia postoesophageal cancer surgery: a prospective longitudinal study protocol. BMJ Open 2022; 12:e058815. [PMID: 36137623 PMCID: PMC9511601 DOI: 10.1136/bmjopen-2021-058815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Dysphagia is a common problem following oesophagectomy, and is associated with aspiration pneumonia, malnutrition, weight loss, prolonged enteral feeding tube dependence, in addition to an extended in-hospital stay and compromised quality of life (QOL). To date, the prevalence, nature and trajectory of post-oesophagectomy dysphagia has not been systematically studied in a prospective longitudinal design. The study aims (1) to evaluate the prevalence, nature and trajectory of dysphagia for participants undergoing an oesophagectomy as part of curative treatment, (2) to determine the risk factors for, and post-operative complications of dysphagia in this population and (3) to examine the impact of oropharyngeal dysphagia on health-related QOL across time points. METHODS AND ANALYSIS A videofluoroscopy will be completed and analysed on both post-operative day (POD) 4 or 5 and at 6-months post-surgery. Other swallow evaluations will be completed preoperatively, POD 4 or 5, 1-month and 6-month time points will include a swallowing screening test, tongue pressure measurement, cough reflex testing and an oral hygiene evaluation. Nutritional measurements will include the Functional Oral Intake Scale to measure feeding tube reliance, Malnutrition Screening Tool and the Strength, Assistance With Walking, Rise From a Chair, Climb Stairs and Falls questionnaire. The Reflux Symptom Index will be administered to investigate aerodigestive symptoms commonly experienced by adults post-oesophagectomy. Swallowing-related QOL outcome measures will be determined using the European Organisation for Research and Treatment of Cancer QLQ-18, MD Anderson Dysphagia Inventory and the Swallowing Quality of Life Questionnaire. ETHICS AND DISSEMINATION Ethical approval has been granted by the Tallaght University Hospital/St. James' Hospital Research Ethics Committee (JREC), Dublin, Ireland (Ref. No. 2021-Jul-310). The study results will be published in peer-reviewed journals and presented at national and international scientific conferences.
Collapse
Affiliation(s)
- Michelle Hayes
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
- Senior Upper GI and ICU Speech and Language Therapist, St. James's Hospital, Dublin, Ireland
| | - Anna Gillman
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Brona Wright
- Patient and Public Representative Group, Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sean Dorgan
- Patient and Public Representative Group, Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Ian Brennan
- Department of Radiology, St. James's Hospital, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Claire Donohoe
- Consultant Gastrointestinal Surgeon, Department of Surgery, St. James's Hospital, Dublin, Ireland
| | - John V Reynolds
- Consultant Gastrointestinal Surgeon, Department of Surgery, St. James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
|
9
|
Komatsu S, Konishi T, Matsubara D, Soga K, Shimomura K, Ikeda J, Taniguchi F, Iwase H, Kubota T, Shioaki Y, Otsuji E. Night home enteral nutrition as a novel enforced and physiologically effective nutrition therapy following total gastrectomy for gastric cancer. Sci Rep 2022; 12:14922. [PMID: 36056110 PMCID: PMC9440117 DOI: 10.1038/s41598-022-17420-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/25/2022] [Indexed: 01/07/2023] Open
Abstract
Enteral nutrition has been reported to be safe and effective in malnourished patients undergoing upper gastrointestinal surgery. In this study, we devised night home enteral nutrition (N-HEN) as a novel nutritional strategy and evaluated the efficacy in gastric cancer patients following total gastrectomy. Between January 2017 and March 2021, 24 patients were prospectively included in the protocol and supported by N-HEN for three postoperative months through a jejunostomy during the night (Elental:1200 kcal/day), and 22 patients without N-HEN were followed as a control group (CG). Body weight loss, nutritional indicators and tolerance to chemotherapy were evaluated. After 3 and 6 months, patients with N-HEN had significantly less body weight loss than CG (3 months P < 0.0001: N-HEN 4.0% vs. CG 15.2%, 6 months P < 0.0001: N-HEN 7.7% vs. CG 17.7%). Prealbumin was significantly higher in patients with N-HEN than CG after 3 and 6 months (3 months P < 0.0001, 6 months P = 0.0037). Albumin, total protein and hemoglobin, tended to be higher after 3 and 6 months in patients with N-HEN than CG, and total cholesterol after 6 months. Concerning the tolerance to adjuvant chemotherapy in Stage II-III patients, patients with N-HEN significantly had a higher completion rate (P = 0.0420: N-HEN 70% vs. CG 29%) and longer duration (P = 0.0313: N-HEN 458 days vs. CG 261 days) as planned. Continuous monitoring of blood glucose concentration in patients with N-HEN did not show nocturnal hypoglycemia or hyperglycemia. N-HEN could be a novel enforced and physiologically effective nutritional strategy to support potentially malnourished patients following total gastrectomy.
Collapse
Affiliation(s)
- Shuhei Komatsu
- Department of Digestive Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan.
- Division of Digestive Surgery (Gastric Surgery Division), Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Tomoki Konishi
- Department of Digestive Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Daiki Matsubara
- Department of Digestive Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Koji Soga
- Department of Digestive Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Katsumi Shimomura
- Department of Digestive Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Jun Ikeda
- Department of Digestive Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Fumihiro Taniguchi
- Department of Digestive Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Hiroya Iwase
- Department of Endocrinology and Metabolism, Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery (Gastric Surgery Division), Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yasuhiro Shioaki
- Department of Digestive Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery (Gastric Surgery Division), Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
|
10
|
Kim MS, Shin S, Kim HK, Choi YS, Zo JI, Shim YM, Cho JH. Role of intraoperative feeding jejunostomy in esophageal cancer surgery. J Cardiothorac Surg 2022; 17:191. [PMID: 35987831 PMCID: PMC9392926 DOI: 10.1186/s13019-022-01944-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 08/15/2022] [Indexed: 12/25/2022] Open
Abstract
Background Feeding jejunostomy was routinely placed during esophagectomy to ensure postoperative enteral feeding. Improved anastomosis technique and early oral feeding strategy after esophagectomy has led to question the need for the routine placement of feeding jejunostomy. The aim of this study is to evaluate role of feeding jejunostomy during Ivor Lewis operation.
Methods We retrospectively reviewed 414 patients who underwent the Ivor Lewis operations from January 2015 to December 2018. Results 61 patients (14.7%) received jejunostomy insertion. The most common indication for jejunostomy was neoadjuvant concurrent chemoradiation therapy (CCRT). 48 patients (79%) had jejunostomy removed within 60 days after the surgery and the longest duration of jejunostomy inserted state was 121 days. About two-third of the patients with jejunostomy had never prescribed with an enteral feeding product. Among 353 patients without intraoperative feeding jejunostomy, 11(3.1%) received delayed jejunostomy insertion. Graft-related problems (6 patients), cancer progression (3 patients), acute lung injury (1 patient), and swallowing difficulty (1 patient) were reasons for delayed feeding jejunostomy insertion. Complication rate was relatively high as 24 patients (33.3%) out of 72 patients with jejunostomy insertion had complications and 7 patients (9.7%) visited ER more than twice with jejunostomy-related complications. Conclusion Only 3.6% patients who underwent the Ivor Lewis operation during 4-year span had anastomosis leakage. Although one-third of the patients with jejunostomy were benefited with alternative method of feeding after discharge, high complication rate regarding jejunostomy should be also considered. We believe feeding jejunostomy should not be applied routinely with prophylactic measures and should be reserved to very carefully selected patients with multiple high-risk factors.
Collapse
|
|
11
|
Zhang C, Hu LW, Qiang Y, Cong ZZ, Zheng C, Gu WF, Luo C, Xie K, Shen Y. Home enteral nutrition for patients with esophageal cancer undergoing esophagectomy: A systematic review and meta-analysis. Front Nutr 2022; 9:895422. [PMID: 35967793 PMCID: PMC9366554 DOI: 10.3389/fnut.2022.895422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/16/2022] [Indexed: 12/09/2022] Open
Abstract
Introduction Home enteral nutrition (HEN) is a relatively new nutritional intervention that provides patients with EN support at home through jejunostomy or nasogastric feeding tubes. We conducted this systematic review and meta-analysis to explore the safety and effect of HEN compared with normal oral diet (NOD) in postoperative patients with esophageal cancer (EC). Methods EMBASE, Medline, Web of Science, and the Cochrane Library were used to search articles in English-language journals. The intervention effect was expressed using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcome measures, with 95% confidence intervals (95% CIs). The chi-square test and I-square test were used to test heterogeneity among studies. Results Four studies were eventually included in this meta-analysis. Compared with NOD, HEN has a favorable impact on postoperative body mass index (BMI) (weighted mean difference [WMD] = 0.70, 95% CI: 0.09–1.30, P = 0.02), lean body mass (LBM) (WMD = 0.76, 95% CI: 0.04–1.48, P = 0.04), and appendicular skeletal muscle mass index (ASMI) (WMD = 0.30, 95% CI: 0.02–0.58, P = 0.03). Physical function (WMD = 9.26, 95% CI: 8.00–10.53, P < 0.001), role function (WMD = 9.96, 95% CI: 8.11–11.82, P < 0.001), and social function (WMD = 8.51, 95% CI: 3.48–13.54, P = 0.001) of the HEN group were better than those of the NOD group at 3 months, and HEN could reduce the fatigue of patients (WMD = −12.73, 95% CI: −14.8 to −10.66, P < 0.001) and the incidence of postoperative pneumonia (RR = 0.53, 95% CI: 0.34–0.81, P = 0.004). There was no significant difference in albumin between HEN and NOD groups (WMD = 0.05, 95% CI: −0.03 to 0.13, P = 0.20). Conclusion HEN improved nutritional status and quality of life (QOL) in postoperative patients with EC and reduced fatigue and the incidence of postoperative pneumonia. All in all, the results of our meta-analysis support the use of HEN after esophagectomy.
Collapse
Affiliation(s)
- Chi Zhang
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China
| | - Li-Wen Hu
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China
| | - Yong Qiang
- Department of Cardiothoracic Surgery, School of Medicine, Jinling Hospital, Southeast University, Nanjing, China
| | - Zhuang-Zhuang Cong
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China
| | - Chao Zheng
- Department of Cardiothoracic Surgery, School of Medicine, Jinling Hospital, Southeast University, Nanjing, China
| | - Wen-Feng Gu
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China
| | - Chao Luo
- Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China
| | - Kai Xie
- Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China.,Department of Cardiothoracic Surgery, School of Medicine, Jinling Hospital, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China.,Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
|
12
|
Deftereos I, Yeung JMC, Arslan J, Carter VM, Isenring E, Kiss N, Cardamis A, Dorey A, Ottaway A, Maguire B, Cleeve B, Davis C, Zoanetti C, Gray C, Choong C, Douglas C, Nixon C, Platt D, Quinn E, Simpson E, Hamdorf E, McNamara E, Whelan E, Jegendran G, Moore G, Lockwood G, McNamara J, Corrigan J, Haaksma K, Fox K, Furness K, Cochrane KW, Huynh K, Lee KC, Hames N, Hendricks N, Page N, Brooks N, Nevin L, Parfrey L, Putrus E, Pons R, Hoevenaars R, Singh S, McCoy S, Wallin S, Mexias S, Daniells S, Storr T, Robertson T, Brown T. Adherence to ESPEN guidelines and associations with postoperative outcomes in upper gastrointestinal cancer resection: results from the multi-centre NOURISH point prevalence study. Clin Nutr ESPEN 2022; 47:391-398. [DOI: 10.1016/j.clnesp.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022]
|
|
13
|
Kanie Y, Okamura A, Fujihara A, Matsuo H, Maruyama S, Sakamoto K, Fujiwara D, Kanamori J, Imamura Y, Kumagai K, Watanabe M. Long-Term Insufficiency of Oral Intake after Esophagectomy; Who Needs Intense Nutritional Support after Esophagectomy? ANNALS OF NUTRITION AND METABOLISM 2022; 78:106-113. [PMID: 35038697 DOI: 10.1159/000521893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with esophageal cancer are at a high risk of malnutrition after esophagectomy, and nutritional support may at times be required for several months following surgery. In this study, we aimed to clarify the clinical features and preoperative risk factors of patients with long-term insufficiency of oral intake after esophagectomy by evaluating the duration of feeding enterostomy placement. METHODS A total of 306 patients who underwent esophagectomy, reconstruction with gastric conduit, and feeding enterostomy creation were retrospectively reviewed. We analyzed the clinical features and preoperative risk factors for long-term placement of feeding enterostomy. RESULTS The feeding enterostomy tube was removed less than 90 days after esophagectomy in 234 patients (76.5%) (Short group), whereas 72 patients still needed enteral nutrition after 90 days (23.5%; Long group). Although severe malnutrition was observed more frequently in the long group compared with the short group (p=0.021), overall survival time was comparable between the groups (p=0.239). Multivariate analysis revealed that higher age (OR 1.04; 95% CI, 1.01-1.07; p=0.021), poor performance status(OR 2.94; 95% CI, 1.10-7.87; p=0.032), and lower preoperative body weight(OR 0.96; 95% CI, 0.94-0.99; p=0.009) were the independent variables predicting the long-time placement of feeding enterostomy. CONCLUSION Nutritional support via feeding enterostomy for more than 90 days after esophagectomy was required in 23.5% of patients. The elderly, poor performance status, and lower body weight were the independent preoperative factors for predicting the long-term placement of feeding enterostomy.
Collapse
Affiliation(s)
- Yasukazu Kanie
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Aya Fujihara
- Department of Clinical Nutrition, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiromi Matsuo
- Department of Clinical Nutrition, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Suguru Maruyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kei Sakamoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Daisuke Fujiwara
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Clinical Nutrition, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
|
14
|
Mei LX, Wang YY, Tan X, Chen Y, Dai L, Chen MW. Is it necessary to routinely perform feeding jejunostomy at the time of esophagectomy? A systematic review and meta-analysis. Dis Esophagus 2021; 34:6245102. [PMID: 33884417 DOI: 10.1093/dote/doab017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 12/11/2022]
Abstract
Feeding jejunostomy (FJ) is a routine procedure at the time of esophagectomy in some centers. With the widespread popularization of enhanced recovery after surgery, the necessity of FJ has been increasingly questioned. This study aims to analyze the differences in safety and effectiveness between with (FJ group) or without (no-FJ group) performing FJ at the time of esophagectomy. PubMed, Embase, Web of Science, and Cochrane Library were comprehensively searched for relevant studies, including randomized controlled trials and cohort studies. The primary outcome was the length of hospital stay (LOS). Secondary outcomes were overall postoperative complications, postoperative pneumonia, intestinal obstruction, and weight loss at 3 and 6 months after esophagectomy. Weighted mean differences (WMD) and odds ratios (OR) were calculated for statistical analysis. About 12 studies comprising 2,173 patients were included. The FJ group had a longer LOS (WMD = 2.05, P = 0.01) and a higher incidence of intestinal obstruction (OR = 11.67, P < 0.001) than the no-FJ group. The incidence of overall postoperative complications (OR = 1.24, P = 0.31) and postoperative pneumonia (OR = 1.43, P = 0.13) were not significantly different, nor the weight loss at 3 months (WMD = 0.58, P = 0.24) and 6 months (P > 0.05) after esophagectomy. Current evidence suggests that routinely performing FJ at the time of esophagectomy appears not to generate better postoperative outcomes. FJ may need to be performed selectively rather than routinely. More studies are required to further verify.
Collapse
Affiliation(s)
- Li-Xiang Mei
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yong-Yong Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiang Tan
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yong Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lei Dai
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ming-Wu Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
|
15
|
Murphy CF, Elliott JA, Docherty NG, Mohamed AA, Vincent RP, Ravi N, Reynolds JV, le Roux CW. Exaggerated postprandial GLP-1 secretion following esophagectomy is not associated with gastric emptying and intestinal transit. Dis Esophagus 2021; 34:5907940. [PMID: 32944747 DOI: 10.1093/dote/doaa098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/09/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022]
Abstract
Esophagectomy causes postprandial symptoms associated with an exaggerated postprandial gut hormone response. This study aimed to compare the gastrointestinal transit time of patients 1 year after esophagectomy with unoperated controls, including its relation to satiety gut hormone release. In this cross-sectional study, consecutive, disease-free patients after esophagectomy with pyloroplasty were compared with unoperated control subjects to assess gastric emptying (GE) and cecal arrival time (CAT). Serial plasma samples were collected before, and for 300 minutes after, a mixed-meal challenge. Body composition was assessed, and symptom scores were calculated. Eleven patients 1 year post-esophagectomy (age: 62.6 ± 9.8, male: 82%) did not show a significantly different GE pattern compared with 10 control subjects (P = 0.245). Rather, patients could be categorized bimodally as exhibiting either rapid or slow GE relative to controls. Those with rapid GE trended toward a higher postprandial symptom burden (P = 0.084) without higher postprandial glucagon-like peptide-1 (GLP-1) secretion (P = 0.931). CAT was significantly shorter after esophagectomy (P = 0.043) but was not significantly associated with GE, GLP-1 secretion, or symptom burden. Neither early nutrient delivery to the proximal small intestine nor to the colon explains the exaggerated postprandial GLP-1 response after esophagectomy. GE varies significantly in these patients despite consistent pyloric management.
Collapse
Affiliation(s)
- C F Murphy
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.,National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - J A Elliott
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.,National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - N G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - A A Mohamed
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - R P Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - N Ravi
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - J V Reynolds
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - C W le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| |
Collapse
|
|
16
|
Carmichael L, Rocca R, Laing E, Ashford P, Collins J, Jackson L, McPherson L, Pendergast B, Kiss N. Early postoperative feeding following surgery for upper gastrointestinal cancer: A systematic review. J Hum Nutr Diet 2021; 35:33-48. [PMID: 34089207 DOI: 10.1111/jhn.12930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 01/07/2023]
Abstract
Nutrition post major upper gastrointestinal (UGI) cancer surgery is a significant consideration known to affect postoperative recovery and the ability to tolerate adjuvant treatment. This systematic review assessed the effect of early oral feeding (EOF), compared to traditional timing of oral feeding, following major surgery for UGI cancer on postoperative complications, postoperative length of hospital stay (LOS), nutritional status and quality of life (QOL). The literature was searched up to March 9th 2020 using CINHAL, PubMed, MEDLINE, Embase, Scopus and Web of Science databases. Quality assessment was completed using the Academy of Nutrition and Dietetics quality criteria checklist. Fifteen articles were included, consisting of seven randomised controlled trials, six cohort studies and two non-randomised trials, with a total of 2517 participants. The type and timing of EOF varied considerably across studies with limited reporting of energy and protein intakes from oral or enteral feeding. Fourteen studies assessed postoperative complications of which 13 reported no difference between EOF and standard care. Fourteen studies assessed postoperative LOS and of these, 13 reported a reduced length of stay in the EOF group. Four of 15 studies assessing nutritional status found no difference between groups. Three of 15 studies assessed QOL with inconsistent findings. This review found EOF reduced postoperative LOS and did not increase postoperative complications. However, the optimal timing for the introduction of EOF could not be established. Furthermore, the type of EOF varied considerably making comparison across studies challenging and demonstrates a need for internationally standardised definitions.
Collapse
Affiliation(s)
- Lauren Carmichael
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Rose Rocca
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Erin Laing
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Phoebe Ashford
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Jesse Collins
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Luke Jackson
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Lauren McPherson
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Brydie Pendergast
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| |
Collapse
|
|
17
|
Outcomes of Esophageal Cancer after Esophagectomy in the Era of Early Injection Laryngoplasty. Diagnostics (Basel) 2021; 11:diagnostics11050914. [PMID: 34065599 PMCID: PMC8160664 DOI: 10.3390/diagnostics11050914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: severe weight loss was reported to be related to unilateral vocal fold paralysis (UVFP) after esophagectomy and could thus impair survival. Concomitant radical lymph node dissection along the recurrent laryngeal nerve during esophageal cancer surgery is controversial, as it might induce UVFP. Early intervention for esophagectomy-related UVFP by administering intracordal injections of temporal agents has recently become popular. This study investigated the survival outcomes of esophagectomy for esophageal squamous cell carcinoma (ESCC) after the introduction of early injection laryngoplasty (EIL). (2) Methods: a retrospective review of patients with ESCC after curative-intent esophagectomy was conducted in a tertiary referral medical center. The necessity of EIL with hyaluronic acid was comprehensively discussed for all symptomatic UVFP patients. The survival outcomes and related risk factors of ESCC were evaluated. (3) Results: among the cohort of 358 consecutive patients who underwent esophagectomy for ESCC, 42 (11.7%) showed postsurgical UVFP. Twenty-nine of them received office-based EIL. After EIL, the glottal gap area, maximum phonation time and voice outcome survey showed significant improvement at one, three and six months measurements. The number of lymph nodes in the resected specimen was higher in those with UVFP than in those without UVFP (30.1 ± 15.7 vs. 24.6 ± 12.7, p = 0.011). The Kaplan-Meier overall survival was significantly better in patients who had UVFP (p = 0.014), received neck anastomosis (p = 0.004), underwent endoscopic resection (p < 0.001) and had early-stage cancer (p < 0.001). Multivariate Cox logistic regression analysis showed two independent predictors of OS, showing that the primary stage and anastomosis type are the two independent predictors of OS. (4) Conclusion: EIL is effective in improving UVFP-related symptoms, thus providing compensatory and palliative measures to ensure the patient's postsurgical quality of life. The emerging use of EIL might encourage cancer surgeons to radically dissect lymph nodes along the recurrent laryngeal nerve, thus changing the survival trend.
Collapse
|
|
18
|
Murphy CF, Stratford N, Docherty NG, Moran B, Elliott JA, Healy ML, McMorrow JP, Ravi N, Goldstone AP, Reynolds JV, le Roux CW. A Pilot Study of Gut-Brain Signaling After Octreotide Therapy for Unintentional Weight Loss After Esophagectomy. J Clin Endocrinol Metab 2021; 106:e204-e216. [PMID: 33000149 DOI: 10.1210/clinem/dgaa697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Conor F Murphy
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Nicholas Stratford
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - Brendan Moran
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - Jessie A Elliott
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | | | | | - Narayanasamy Ravi
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, and Computational, Cognitive, and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - John V Reynolds
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| |
Collapse
|
|
19
|
Niihara M, Tsubosa Y, Yamashita A, Mori K, Tsumaki H, Onozawa Y, Fukuda H. Supplemental enteral tube feeding nutrition after hospital discharge of esophageal cancer patients who have undergone esophagectomy. Esophagus 2021; 18:504-512. [PMID: 33475875 PMCID: PMC8172505 DOI: 10.1007/s10388-020-00803-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND After undergoing esophagectomy to treat esophageal cancer, there are changes in the normal intake patterns in most patients, with more than half found to have an inadequate oral intake at the time of their hospital discharge. However, the use of home supplemental enteral tube feeding nutrition after hospital discharge in esophagectomy patients has yet to be established. The aim of this study was to evaluate the feasibility of 90-day home supplemental enteral tube feeding nutrition in esophagectomy patients. METHODS This single-center, prospective, and single-arm study evaluated the feasibility of using supplemental tube feeding nutrition intervention for 90 days in esophageal cancer patients who have undergone esophagectomy. RESULTS This study enrolled 24 post-esophagectomy patients between February 2015 and September 2016. Twenty patients were administered 70% or more of the planned nutrient, with 83% of the patients completing the nutritional intervention procedure. There were no grade 3/4 adverse events observed, with a mean body weight change of - 7.6 ± 6.0%. CONCLUSIONS Our results showed that routine use of 90-day home supplemental enteral tube feeding nutrition after hospital discharge for esophagectomy patients was both feasible and acceptable. TRIAL REGISTRATION UMIN000016286.
Collapse
Affiliation(s)
- Masahiro Niihara
- Shizuoka Cancer Center, Division of Esophageal Surgery, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
- Shizuoka Cancer Center, Nutrition Support Team, Sunto-gun, Japan.
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Yasuhiro Tsubosa
- Shizuoka Cancer Center, Division of Esophageal Surgery, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
- Shizuoka Cancer Center, Nutrition Support Team, Sunto-gun, Japan
| | - Aiko Yamashita
- Shizuoka Cancer Center, Nutrition Support Team, Sunto-gun, Japan
| | - Keita Mori
- Shizuoka Cancer Center, Clinical Trial Coordination Office, Sunto-gun, Japan
| | - Hiromi Tsumaki
- Shizuoka Cancer Center, Nutrition Support Team, Sunto-gun, Japan
| | - Yusuke Onozawa
- Shizuoka Cancer Center, Nutrition Support Team, Sunto-gun, Japan
| | - Hiroyuki Fukuda
- Shizuoka Cancer Center, Nutrition Support Team, Sunto-gun, Japan
| |
Collapse
|
|
20
|
Home enteral nutrition and oral nutritional supplements in postoperative patients with upper gastrointestinal malignancy: A systematic review and meta-analysis. Clin Nutr 2020; 40:3082-3093. [PMID: 33279310 DOI: 10.1016/j.clnu.2020.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/31/2020] [Accepted: 11/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The safety and potential benefits of home enteral route nutrition (HERN), referring specifically to home enteral nutrition (HEN) and oral nutritional supplements (ONS) in this article, after upper gastrointestinal (GI) resection are inconsistent. OBJECTIVE To evaluate the impact of HERN on nutritional status, complications, and quality of life (QOL) after upper GI resection. METHODS This systematic review was conducted in accordance with the PRISMA statement. Nine databases were searched from inception to October 2019. Randomized controlled trials (RCTs) comparing the impact of HERN after upper gastrointestinal resection were included. Relative risk/weighted mean difference/standardized mean difference (RR/WMD/SMD) and corresponding 95% confidence intervals (95% CI) were calculated using fixed- or random-effects models. RESULTS Overall, 15 RCTs involving 1059 patients were included. Compared with normal oral diet, HERN significantly prevented weight loss (-3.95 vs -5.82 kg; SMD: 1.98 kg; 95% CI: 1.24-2.73); improved added-level of albumin (3.48 vs 2.41 g/L; SMD: 1.36 g/L; 95% CI: 0.81-1.91), hemoglobin (6.54 vs -1.29 g/L; WMD: 7.45 g/L; 95% CI: 5.05-9.86), pre-albumin (37.59 vs 7.35 mg/L; WMD: 21.6 mg/L; 95% CI: 5.96-37.24), and transferrin (63.08 vs 50.45 mg/L; WMD: 16.44 mg/L; 95% CI: 13.51-19.38); and reduced the incidence of malnutrition or latent malnutrition (RR = 0.54; P < 0.01). Subgroup analysis based on the approach of HERN showed that weight loss in the HEN subgroup was significantly lower than that of the control group (WMD = 2.69, P < 0.01), while there was no significant difference between the ONS subgroup and the control group (P = 0.1). The same results were found in albumin. Physical function (WMD: 5.29; 95% CI: 1.86-8.73) and fatigue (WMD: -8.59; 95% CI: -12.61, -4.58) dimensions in QOL were significantly better in the HERN group. No significant differences in gastrointestinal and tube-related complications. CONCLUSION HERN improved nutritional status and some dimensions of QOL in upper GI malignancy patients after surgery, without increasing complications. Subgroup analysis showed that HEN experienced more benefits than ONS.
Collapse
|
|
21
|
Carroll PA, Yeung JC, Darling GE. Elimination of Routine Feeding Jejunostomy After Esophagectomy. Ann Thorac Surg 2020; 110:1706-1713. [DOI: 10.1016/j.athoracsur.2020.04.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 01/15/2023]
|
|
22
|
Wobith M, Wehle L, Haberzettl D, Acikgöz A, Weimann A. Needle Catheter Jejunostomy in Patients Undergoing Surgery for Upper Gastrointestinal and Pancreato-Biliary Cancer-Impact on Nutritional and Clinical Outcome in the Early and Late Postoperative Period. Nutrients 2020; 12:E2564. [PMID: 32854177 PMCID: PMC7551703 DOI: 10.3390/nu12092564] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 12/29/2022] Open
Abstract
The metabolic risk for patients undergoing abdominal cancer resection increases in the perioperative period and malnutrition may be observed. In order to prevent further weight loss, the guidelines recommend for high-risk patients the placement of a needle catheter jejunostomy (NCJ) for supplementing enteral feeding in the early and late postoperative period. Our aim was to evaluate the safety of NCJ placement and its potential benefits regarding the nutritional status in the postoperative course. We retrospectively analyzed patients undergoing surgery for upper gastrointestinal cancer, such as esophageal, gastric, and pancreato-biliary cancer, and NCJ placement during the operation. The nutritional parameters body mass index (BMI), perioperative weight loss, phase angle measured by bioelectrical impedance analysis (BIA) and the clinical outcome were assessed perioperatively and during follow-up visits 1 to 3 months and 4 to 6 months after surgery. In 102 patients a NCJ was placed between January 2006 and December 2016. Follow-up visits 1 to 3 months and 4 to 6 months after surgery were performed in 90 patients and 88 patients, respectively. No severe complications were seen after the NCJ placement. The supplementing enteral nutrition via NCJ did not improve the nutritional status of the patients postoperatively. There was a significant postoperative decline of weight and phase angle, especially in the first to third month after surgery, which could be stabilized until 4-6 months after surgery. Placement of NCJ is safe. In patients with upper gastrointestinal and pancreato-biliary cancer, supplementing enteral nutrition during the postoperative course and continued after discharge may attenuate unavoidable weight loss and a reduction of body cell mass within the first six months.
Collapse
Affiliation(s)
| | | | | | | | - Arved Weimann
- Clinical Nutrition Unit of the Department of General, Visceral, and Oncological Surgery, Klinikum St. Georg gGmbH Leipzig, 04103 Leipzig, Germany; (M.W.); (L.W.); (D.H.); (A.A.)
| |
Collapse
|
|
23
|
Deftereos I, Yeung JMC, Carter VM, Isenring E, Kiss NK. Nutritional Outcomes of patients Undergoing Resection for upper gastroIntestinal cancer in AuStralian Hospitals (NOURISH): protocol for a multicentre point prevalence study. BMJ Open 2020; 10:e035824. [PMID: 32385064 PMCID: PMC7228529 DOI: 10.1136/bmjopen-2019-035824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Nutritional intervention and prevention of malnutrition is significantly important for patients with upper gastrointestinal oesophageal, pancreatic and gastric cancer. However, there is limited information regarding nutritional status, and perioperative nutritional interventions that patients receive when undergoing curative surgery. METHODS AND ANALYSIS Patients diagnosed with upper gastrointestinal cancer, planned for curative intent resection across 27 Australian hospitals will be eligible to participate in this point prevalence study. The primary aim is to determine the prevalence of malnutrition in patients with upper gastrointestinal cancer at the time of surgery using subjective global assessment. Secondary aims are to determine the type and frequency of perioperative nutritional intervention received, the prevalence of clinically important weight loss and low muscle strength, and to investigate associations between the use of an evidence-based nutrition care pathway or protocol for the nutritional management of upper gastrointestinal surgical oncology patients and malnutrition prevalence. Data collection will be completed using a purpose-built data collection tool. ETHICS AND DISSEMINATION Ethical approval was granted in May 2019 (LNR/51107/PMCC-2019). The design and reporting of this study comply with the Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting of observational cohort studies. Findings will be published in peer-reviewed scholarly journals and presented at relevant conferences. Results will assist in defining priority areas for research to improve patient outcomes.
Collapse
Affiliation(s)
- Irene Deftereos
- Department of Surgery Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Nutrition and Dietetics, Western Health, Footscray, Victoria, Australia
| | - Justin M C Yeung
- Department of Surgery Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
- Western Chronic Disease Alliance, Western Health, Melbourne, Victoria, Australia
| | - Vanessa M Carter
- Nutrition and Dietetics, Western Health, Footscray, Victoria, Australia
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicole K Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
|
24
|
Nutritional management of patients with oesophageal cancer throughout the treatment trajectory: benchmarking against best practice. Support Care Cancer 2020; 28:5963-5971. [PMID: 32281035 DOI: 10.1007/s00520-020-05416-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/13/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Oesophageal cancer (OC) impacts nutritional status and outcomes. This study aims to benchmark the current nutrition management of patients with OC against best practice recommendations, identify critical points in the treatment trajectory where nutritional status is compromised, service gaps and opportunities for improvement. METHODS A retrospective audit collected demographic, medical and nutritional data from medical records of patients who received curative treatment for OC at a tertiary referral hospital in Sydney, Australia. RESULTS Thirty-seven patient records were audited over the time period. Twenty-nine patients underwent nutrition screening on admission to the service. Eighteen out of 25 patients receiving neoadjuvant radiation therapy, all patients during surgical admission, and only 19 patients at postsurgical discharge were seen by a dietitian. All patients received tube feeding post-operatively; however, initiation within 24 h only occurred for 14 patients. Weight significantly declined over the course of treatment (p < 0.001), whilst malnutrition during surgical admission (p = 0.004) and postsurgical discharge (p = 0.038) were both associated with significantly higher unplanned readmissions. CONCLUSIONS Best practice recommendations were met for aspects of the immediate post-operative period; however, service gaps remain during pre-operative and post-discharge care. Findings from this study indicate that nutritional care is inconsistent across different treatment stages, and malnutrition impacts negatively on unplanned readmission. Research is needed to address evidence-practice gaps, assess appropriateness of recommendations and provide evidence for models of care during multimodality treatments and across different services.
Collapse
|
|
25
|
Shiraishi O, Kato H, Iwama M, Hiraki Y, Yasuda A, Peng YF, Shinkai M, Kimura Y, Imano M, Yasuda T. Simplified percutaneous endoscopic transgastric conduit feeding jejunostomy for dysphagia after esophagectomy. Dis Esophagus 2020; 33:5487254. [PMID: 31069391 DOI: 10.1093/dote/doz042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/13/2019] [Accepted: 04/05/2019] [Indexed: 12/11/2022]
Abstract
Unexpected dysphagia is an important problem affecting life prognosis in patients who have undergone an esophagectomy for esophageal cancer. For nutritional support in patients suffering from dysphagia after a previous esophagectomy, a simplified percutaneous endoscopic transgastric conduit feeding jejunostomy approach was developed that can be performed regardless of the patient's condition. The feasibility of this procedure in 25 patients with esophageal cancer who underwent three-stage esophagectomy with retrosternal gastric conduit reconstruction from April 2009 to December 2016 was evaluated retrospectively. Under fluoroscopy, a percutaneous endoscopic transgastric conduit feeding jejunostomy catheter (9 French) was introduced into the jejunum in the epigastric region using the Seldinger's technique. The following patient data were analyzed retrospectively: operating time, complications, reasons for oral intake difficulty, and clinical data describing patients' nutritional status before and 1 month after percutaneous endoscopic transgastric conduit jejunostomy treatment, such as serum albumin and clinical course. Median patients' age was 68 years (range 50-76 years). Indications for the procedure were late swallowing dysfunction (n = 12), early swallowing dysfunction secondary to surgical complication (n = 8), anastomotic leakage (n = 3), and anorexia (n = 2). Causes of late swallowing dysfunction were radiation injury (n = 8), advanced age (n = 2), or cerebral infarction (n = 2). The median operating time was 29 minutes (range 14-82 minutes). Four patients developed mild erosions at the stoma secondary to bile reflux along the side of the catheter. No patient experienced severe complications such as ileus and peritonitis. Patients were treated for a median of 160 days (range 18-3106 days) with percutaneous endoscopic transgastric conduit jejunostomy. Patient's serum albumin significantly increased from 2.8 to 3.3 g/dl in 1 month. Of the eight patients with early swallowing dysfunction, six successfully regained sufficient oral nutrition after receiving enteral feeding nutritional management. Although all except one late swallowing dysfunction patient could not discontinue tube feeding, five patients were long-term survivors at the time this report was written. This jejunostomy procedure is simple, safe, and useful for patients with unexpected dysphagia and accompanying malnutrition after esophagectomy.
Collapse
Affiliation(s)
- Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Hiroaki Kato
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Mituru Iwama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yoko Hiraki
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Atsushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Ying-Feng Peng
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Masayuki Shinkai
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Motohiro Imano
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| |
Collapse
|
|
26
|
Shiraishi O, Kato H, Iwama M, Hiraki Y, Yasuda A, Peng YF, Shinkai M, Kimura Y, Imano M, Yasuda T. A simple, novel laparoscopic feeding jejunostomy technique to prevent bowel obstruction after esophagectomy: the "curtain method". Surg Endosc 2019; 34:4967-4974. [PMID: 31820160 DOI: 10.1007/s00464-019-07289-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Feeding jejunostomy (FJ) is a common treatment to support patients with esophageal cancer after esophagectomy. However, severe FJ-related complications, such as bowel obstruction, occasionally occur. We investigated the ability of our simple, novel FJ technique, the "curtain method," to prevent bowel obstruction. METHODS In laparoscopic surgery, the main mechanism of bowel obstruction involves torsion of the mesentery accompanied by migration of the intestine across the fixed FJ through the space surrounded by a triangle comprising the ligament of Treitz, fixed FJ, and spleen rather than adhesion. Our "curtain method" involves closure of this triangle zone with omentum, and the appearance of the lifted omentum resembles a curtain. Sixty patients treated with this modified FJ were retrospectively compared with 13 patients treated with conventional FJ in terms of the incidence of bowel obstruction, peritonitis, stoma site infection, and catheter obstruction. RESULTS From 2013 to 2017, 60 patients underwent esophagectomy and gastric conduit reconstruction accompanied by modified laparoscopic FJ. The median observation period, including the period after tube removal, was 644 days. No FJ-associated bowel obstruction, the prevention of which was the primary aim, occurred in any patient. Likewise, no peritonitis or dislodgement occurred. Eight patients (13%) developed a stoma site infection with granulation. The feeding tube became occluded in 11 patients (18%); however, a new feeding tube was reinserted under fluoroscopy for all of these patients. From 2003 to 2012, 13 patients underwent conventional FJ. The median observation period was 387 days. Three patients (23%) developed bowel obstruction by torsion 71 to 134 days after the first surgery, and all were treated by emergency operations. Other FJ-related complications were not different from those in the modified FJ group. CONCLUSION Our simple, novel technique, the "curtain method," for prevention of laparoscopic FJ-associated bowel obstruction after esophagectomy is a safe additional surgery.
Collapse
Affiliation(s)
- Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan.
| | - Hiroaki Kato
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Mitsuru Iwama
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Yoko Hiraki
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Atsushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Ying-Feng Peng
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Masayuki Shinkai
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Motohiro Imano
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan
| |
Collapse
|
|
27
|
Gabiatti CTB, Martins MCL, Miyazaki DL, Silva LP, Lascala F, Macedo LT, Mendes MCS, Carvalheira JBC. Myosteatosis in a systemic inflammation-dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer. Cancer Med 2019; 8:6967-6976. [PMID: 31571402 PMCID: PMC6853837 DOI: 10.1002/cam4.2593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/08/2019] [Accepted: 09/15/2019] [Indexed: 02/05/2023] Open
Abstract
Increased adiposity and its attendant metabolic features as well as systemic inflammation have been associated with prognosis in locally advanced esophageal cancer (LAEC). However, whether myosteatosis and its combination with systemic inflammatory markers are associated with prognosis of esophageal cancer is unknown. Our study aimed to investigate the influence of myosteatosis and its association with systemic inflammation on progression-free survival (PFS) and overall survival (OS) in LAEC patients treated with definitive chemoradiotherapy (dCRT). We retrospectively gathered information on 123 patients with LAEC submitted to dCRT at the University of Campinas Hospital. Computed tomography (CT) images at the level of L3 were analyzed to assess muscularity and adiposity. Systemic inflammation was mainly measured by calculating the neutrophil-to-lymphocyte ratio (NLR). Median PFS for patients with myosteatosis (n = 72) was 11.0 months vs 4.0 months for patients without myosteatosis (n = 51) (hazard ratio [HR]: 0.53; 95% confidence interval [CI], 0.34-0.83; P = .005). Myosteatosis was also independently associated with a favorable OS. Systemic inflammation (NLR > 2.8) was associated with a worse prognosis. The combination of myosteatosis with systemic inflammation revealed that the subgroup of patients with myosteatosis and without inflammation presented less than half the risk of disease progression (HR: 0.47; 95% CI: 0.26-0.85; P = .013) and death (HR: 0.39; 95% CI, 0.21-0.72; P = .003) compared with patients with inflammation. This study demonstrated that myosteatosis without systemic inflammation was independently associated with favorable PFS and OS in LAEC patients treated with dCRT.
Collapse
Affiliation(s)
- Camila T. B. Gabiatti
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Mariane C. L. Martins
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Daniela L. Miyazaki
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Leandro P. Silva
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Fabiana Lascala
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Ligia T. Macedo
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Maria Carolina Santos Mendes
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - José Barreto Campello Carvalheira
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| |
Collapse
|
|
28
|
Al-Temimi MH, Dyurgerova AM, Kidon M, Johna S. Feeding Jejunostomy Tube Placed during Esophagectomy: Is There an Effect on Postoperative Outcomes? Perm J 2019; 23:18.210. [PMID: 31496496 DOI: 10.7812/tpp/18.210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Feeding jejunostomy (FJ) tubes are routinely placed during esophagectomy. However, their effect on immediate postoperative outcomes in this patient population is not clear. OBJECTIVES To evaluate the effect of FJ tube placement during esophagectomy on postoperative morbidity and mortality. METHODS The National Surgical Quality Improvement Program database was used to evaluate the effect of FJ tube placement during esophagectomy on 30-day postoperative morbidity and mortality rates. A propensity score-matched cohort was used to compare postoperative outcomes of patients with and without FJ tubes. RESULTS An FJ tube was placed in 45% of 2059 patients undergoing esophagectomy. The anastomotic leak rate was 13.5%. Patients with FJ tubes were more likely to have preoperative radiation therapy (59.6% vs 54.9%, p = 0.041), transhiatal esophagectomy (21.5% vs 19.2%, p = 0.012), a malignant diagnosis (93.2% vs 90.4%), and longer operative time (393 min vs 348 min, p < 0.001). In a case-matched cohort, mortality (2% vs 2.4%, p = 0.618) and severe morbidity (38.2% vs 34.6%, p = 0.128) were comparable between patients with and without FJ tubes. FJ tube placement was associated with higher overall morbidity (46% vs 38.6%, p = 0.002), superficial wound infection (6.3% vs 2.9%, p = 0.001), and return to the operating room (16.7% vs 12.5%, p = 0.016). In a subgroup of patients with anastomotic leak, FJ was associated with shorter hospital stay (20.1 days vs 24.3 days, p = 0.046). CONCLUSION These mixed findings support selective rather than routine FJ tube placement during esophagectomy.
Collapse
Affiliation(s)
- Mohammed H Al-Temimi
- Department of Surgery, Fontana Medical Center, CA.,Department of Surgery, Baylor University Medical Center, Dallas, TX
| | | | - Michael Kidon
- Touro University of Osteopathic Medicine, Henderson, NV
| | - Samir Johna
- Department of Surgery, Fontana Medical Center, CA
| |
Collapse
|
|
29
|
Elliott JA, O'Byrne L, Foley G, Murphy CF, Doyle SL, King S, Guinan EM, Ravi N, Reynolds JV. Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer. Br J Surg 2019; 106:1341-1351. [PMID: 31282584 DOI: 10.1002/bjs.11218] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/16/2019] [Accepted: 03/26/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND It remains controversial whether neoadjuvant chemoradiation (nCRT) for oesophageal cancer influences operative morbidity, in particular pulmonary, and quality of life. This study combined clinical outcome data with systematic evaluation of pulmonary physiology to determine the impact of nCRT on pulmonary physiology and clinical outcomes in locally advanced oesophageal cancer. METHODS Consecutive patients treated between 2010 and 2016 were included. Three-dimensional conformal radiation was standard, with a lung dose-volume histogram of V20 less than 25 per cent, and total radiation between 40 and 41·4 Gy. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) were assessed at baseline and 1 month after nCRT. Radiation-induced lung injury (grade 2 or greater), comprehensive complications index (CCI) and pulmonary complications were monitored prospectively. Health-related quality of life was assessed among disease-free patients in survivorship. RESULTS Some 228 patients were studied. Comparing pulmonary physiology values before with those after nCRT, FEV1 decreased from mean(s.d.) 96·8(17·7) to 91·5(20·4) per cent (-3·6(10·6) per cent; P < 0·001), FVC from 104·9(15·6) to 98·1(19·8) per cent (-3·2(11·9) per cent; P = 0·005) and DLCO from 97·6(20·7) to 82·2(20·4) per cent (-14·8(14·0) per cent; P < 0·001). Five patients (2·2 per cent) developed radiation-induced lung injury precluding surgical resection. Smoking (P = 0·005) and increased age (P < 0·001) independently predicted percentage change in DLCO. Carboplatin and paclitaxel with 41·4 Gy resulted in a greater DLCO decline than cisplatin and 5-fluorouracil with 40 Gy (P = 0·001). On multivariable analysis, post-treatment DLCO predicted CCI (P = 0·006), respiratory failure (P = 0·020) and reduced physical function in survivorship (P = 0·047). CONCLUSION These data indicate that modern nCRT alters pulmonary physiology, in particular diffusion capacity, which is linked to short- and longer-term clinical consequences, highlighting a potentially modifiable index of risk.
Collapse
Affiliation(s)
- J A Elliott
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St James's Hospital, Dublin, Ireland
| | - L O'Byrne
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St James's Hospital, Dublin, Ireland
| | - G Foley
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - C F Murphy
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St James's Hospital, Dublin, Ireland
| | - S L Doyle
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St James's Hospital, Dublin, Ireland.,School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - S King
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St James's Hospital, Dublin, Ireland
| | - E M Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - N Ravi
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St James's Hospital, Dublin, Ireland
| | - J V Reynolds
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St James's Hospital, Dublin, Ireland
| |
Collapse
|
|
30
|
Ericson J, Lundell L, Klevebro F, Kamiya S, Nilsson M, Rouvelas I. Long-term weight development after esophagectomy for cancer-comparison between open Ivor-Lewis and minimally invasive surgical approaches. Dis Esophagus 2019; 32:5142515. [PMID: 30351390 DOI: 10.1093/dote/doy075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophagectomy is an extensive procedure with severe postoperative effects. It can be assumed that the greater the trauma, the longer the nutritional recovery. This retrospective observational single-center cohort study compared weight development after esophagectomy with open and minimally invasive techniques. Three groups were compared in this study, one representing the first 41 patients who underwent the minimally invasive McKeown esophagectomy (MIMK). The second group included the first 84 consecutive patients operated with the minimally invasive Ivor-Lewis esophagectomy (MIIL). The third group comprised 100 consecutive patients operated with open thoracoabdominal Ivor-Lewis esophagectomy (IL). Virtually all patients submitted to a minimally invasive esophagectomy (MIE) and the majority with an IL had a jejunal catheter inserted during operation for postoperative enteral feeding. All together 225 patients were included in this study. The mean weight loss during the first year was 13.1% (±4.1), 11.2% (±6.1), and 9.6% (±7.5) in the IL, MIIL, and MIMK group, respectively (P = 0.85 and P = 0.95, respectively). The median duration of postoperative enteral nutrition support varied substantially within the groups and was 23.5 days in the IL group (range: 0-2033 days), 54.5 days in those having an MIIL (range: 0-308 days; P ≤ 0.001) and 57.0 days among patients in the MIMK group (range: 0-538 days; P ≤ 0.022). There was no difference in the risk of losing at least 10% of the preoperative weight at 3 or 6 months postoperatively between the groups. However, in patients who suffered severe complications (Clavien-Dindo score ≥ IIIb) after MIIL, there was a nonsignificant trend toward a lower risk of a 10% or greater weight loss, 3 months postoperatively. In conclusion, the greater surgical trauma associated with the traditional open esophagectomy was not followed by more severe weight loss, or other signs of poorer nutritional recovery, when compared to minimal invasive surgical techniques.
Collapse
Affiliation(s)
- J Ericson
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Function area Clinical Nutrition
| | - L Lundell
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - F Klevebro
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - S Kamiya
- Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Nilsson
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - I Rouvelas
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
|
31
|
Lorimer PD, Motz BM, Watson M, Trufan SJ, Prabhu RS, Hill JS, Salo JC. Enteral Feeding Access Has an Impact on Outcomes for Patients with Esophageal Cancer Undergoing Esophagectomy: An Analysis of SEER-Medicare. Ann Surg Oncol 2019; 26:1311-1319. [PMID: 30783851 DOI: 10.1245/s10434-019-07230-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Optimal nutrition after esophagectomy is challenging due to alterations in eating, both from the tumor and during surgical recovery. Enteral nutrition via feeding tube is commonly used. The impact of feeding tubes on post-esophagectomy outcomes was examined in a large national data set. METHODS Patients with esophageal cancer (1998-2013) undergoing esophagectomy were extracted from the Surveillance Epidemiology and End Results-Medicare database. Chi-square and t tests were used to compare categorical and continuous variables. Time trend analyses were performed with Cochran-Armitage survival using log-rank and multivariable analysis with generalized linear modeling. RESULTS The study examined 2495 patients. The majority had enteral feeding access (71%, n = 1794) during the perioperative period. Mortality among the patients with feeding tubes was lower at 30 days (5.4% vs 8.4%), 60 days (9.0% vs 13.0%), and 90 days (12.2% vs 15.8%). In the multivariable analysis, the patients with feeding tubes had improved short-term survival at 30 days (odds ratio [OR], 0.65, 95% confidence interval [CI], 0.46-0.93), 60 days (OR, 0.64; 95% CI, 0.49-0.85), and 90 days (OR, 0.70; 95% CI, 0.54-0.90). The hospital stay was shorter for the patients undergoing enteral feeding tube placement (17.9 vs 19.5 days; p = 0.04). Discharge destination (home vs health care facility) showed no difference. CONCLUSIONS Feeding tubes in patients undergoing esophagectomy were associated with an increase in short-term survival up to 90 days after surgery. Feeding tube placement was not associated with higher rates of non-home discharges and did not prolong the hospital stay.
Collapse
Affiliation(s)
- Patrick D Lorimer
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Benjamin M Motz
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Michael Watson
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Sally J Trufan
- Department of Biostatistics, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | | | - Joshua S Hill
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Jonathan C Salo
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
| |
Collapse
|
|
32
|
Akiyama Y, Iwaya T, Endo F, Nikai H, Sato K, Baba S, Chiba T, Kimura T, Takahara T, Nitta H, Otsuka K, Mizuno M, Kimura Y, Koeda K, Sasaki A. Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy. J Thorac Dis 2018; 10:6854-6862. [PMID: 30746231 DOI: 10.21037/jtd.2018.11.97] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Previous studies have shown that enteral nutrition (EN) helps reduce severe postoperative complications after esophagectomy. However, the incidence of jejunostomy-related complications is approximately 30%. We evaluated the operative outcomes in patients who did not receive EN via feeding jejunostomy after esophagectomy. Methods We retrospectively reviewed 76 consecutive patients with esophageal cancer who received radical esophagectomy. Operative outcomes were compared between 33 patients who received postoperative EN via feeding jejunostomy (group A; from May 2014 to September 2015) and 43 patients who did not receive EN via feeding jejunostomy (group B; from September 2015 to December 2017). Results The American Society of Anesthesiologists performance status score of the patients in group B was significantly higher than that of patients in group A (P=0.002). The postoperative morbidity rate was comparable between the two groups (group A, 30.3% vs. group B, 44.2%, P=0.217). No significant between-group differences were observed in the incidence of infectious complications, postoperative hospital stay, readmission within 30 days after discharge, or pneumonia after discharge within 6 months. The incidence of bowel obstruction was significantly higher in group A than in group B (group A, 9.1% vs. group B, 0%, P=0.044). Two patients in group B required nutritional support via total parenteral nutrition due to bilateral vocal cord palsy or pneumonia. Conclusions Jejunostomy-related bowel obstruction in the patients with feeding jejunostomy was significantly higher than that in the patients without jejunostomy. There was no increase in postoperative complications (including pneumonia) in the patients who did not receive EN via feeding jejunostomy. Our results suggest that routine feeding jejunostomy may not be necessary for all patients undergoing esophagectomy.
Collapse
Affiliation(s)
- Yuji Akiyama
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takeshi Iwaya
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Fumitaka Endo
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Kei Sato
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Shigeaki Baba
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takehiro Chiba
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Toshimoto Kimura
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Koki Otsuka
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Masaru Mizuno
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yusuke Kimura
- Department of Palliative Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Keisuke Koeda
- Department of Medical Safety Science, Iwate Medical University School of Medicine, Iwate, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| |
Collapse
|
|
33
|
Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M, Law S, Lindblad M, Maynard N, Neal J, Pramesh CS, Scott M, Mark Smithers B, Addor V, Ljungqvist O. Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg 2018; 43:299-330. [DOI: 10.1007/s00268-018-4786-4] [Citation(s) in RCA: 239] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
|
34
|
Nassri A, Zhu H, Wang DH, Ramzan Z. Serum Albumin at Diagnosis is an Independent Predictor of Early Mortality in Veteran Patients with Esophageal Cancer. Nutr Cancer 2018; 70:1246-1253. [PMID: 30235013 DOI: 10.1080/01635581.2018.1512639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS To identify independent factors that could predict mortality within 6 months in a cohort of patients with esophageal cancer. METHODS Esophageal cancer patients were grouped into early (≤6 months, n = 41) and late (>6 months, n = 81) mortality groups. 52 variables were analyzed by univariable analysis (UA). A multivariable (MVA) regression model was created to identify predictors of early mortality. RESULTS When comparing early and late mortality groups, there was no difference in age, BMI, race, histology, or anatomic location between the two groups. UA demonstrated that the early mortality group had a lower mean albumin level (3.3 ± 0.1 g/dl vs. 3.8 ± 0.1 g/dl; P < 0.001), poorer ECOG performance status (1.9 ± 0.2 vs. 1.1 ± 0.1, P = 0.02), higher WBC count (9.6 ± 0.7 K/µL vs. 8.2 ± 0.3 K/µL, P = 0.04), and were less likely to receive surgery (2.4% vs. 22.2%; P = 0.003), neoadjuvant treatment (4.9% vs. 28.4%; P = 0.009) and definitive chemoradiation (7.3% vs. 27.2%; P = 0.01). MVA revealed that only low albumin at diagnosis was an independent predictor of survival (P = 0.016). CONCLUSION Albumin level at diagnosis is an independent predictor of early mortality and might be used with other variables to provide prognostic information for patients and to guide treatment.
Collapse
Affiliation(s)
- Ammar Nassri
- a Gastrointestinal Section, Department of Internal Medicine , VA North Texas Healthcare System , Dallas , Texas , USA.,b Department of Gastroenterology , University of Florida at Jacksonville , Jacksonville , Florida , USA
| | - Hong Zhu
- c Department of Clinical Science, Simmons Comprehensive Cancer Center , University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - David H Wang
- d Division of Hematology-Oncology, Simmons Comprehensive Cancer Center , University of Texas Southwestern Medical Center , Dallas , Texas , USA.,e Medical Service, VA North Texas Health Care System , Dallas , Texas , USA
| | - Zeeshan Ramzan
- a Gastrointestinal Section, Department of Internal Medicine , VA North Texas Healthcare System , Dallas , Texas , USA.,f Division of Gastroenterology, University Of Texas Southwestern Medical Center , Dallas , Texas , USA
| |
Collapse
|
|
35
|
Chen MJ, Wu IC, Chen YJ, Wang TE, Chang YF, Yang CL, Huang WC, Chang WK, Sheu BS, Wu MS, Lin JT, Chu CH. Nutrition therapy in esophageal cancer-Consensus statement of the Gastroenterological Society of Taiwan. Dis Esophagus 2018; 31:5025886. [PMID: 29860406 DOI: 10.1093/dote/doy016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A number of clinical guidelines on nutrition therapy in cancer patients have been published by national and international societies; however, most of the reviewed data focused on gastrointestinal cancer or non-cancerous abdominal surgery. To collate the corresponding data for esophageal cancer (EC), a consensus panel was convened to aid specialists from different disciplines, who are involved in the clinical nutrition care of EC patients. The literature was searched using MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the ISI Web of Knowledge. We searched for the best evidence pertaining to nutrition therapy in the case of EC. The panel summarized the findings in 3 sections of this consensus statement, based on which, after the diagnosis of EC, an initial distinction is made between the patients, as follows: (1) Assessment; (2) Therapy in patients with resectable disease; patients receiving chemotherapy or chemoradiotherapy prior to resection, and patients with unresectable disease, requiring chemoradiotherapy or palliative therapy; and (3) Formula. The resulting consensus statement reflects the opinions of a multidisciplinary group of experts, and a review of the current literature, and outlines the essential aspects of nutrition therapy in the case of EC. The statements are: Patients with EC are among one of the highest risk to have malnutrition. Patient generated suggestive global assessment is correlated with performance status and prognosis. Nutrition assessment for patients with EC at the diagnosis, prior to definitive therapy and change of treatment strategy are suggested and the timing interval can be two weeks during the treatment period, and one month while the patient is stable. Patients identified as high risk of malnutrition should be considered for preoperative nutritional support (tube feeding) for at least 7-10 days. Various routes for tube feedings are available after esophagectomy with similar nutrition support benefits. Limited intrathoracic anastomotic leakage postesophagectomy can be managed with intravenous antibiotics and self-expanding metal stent (SEMS) or jejunal tube. Enteral nutrition in patients receiving preoperative chemotherapy or chemoradiation provides benefits of maintaining weight, decreasing toxicity, and preventing treatment interruption. Tube feeding or SEMS can offer nutrition support in patients with unresectable esophageal cancer, but SEMS is not recommended for those with neoadjuvant chemoradiation before surgery. Enteral immunonutrition may preserve lean body mass and attenuates stress response after esophagectomy. Administration of glutamine may decrease the severity of chemotherapy induced mucositis. Enteral immunonutrition achieves greater nutrition status or maintains immune functions during concurrent chemoradiation.
Collapse
Affiliation(s)
- M-J Chen
- Division of Gastroenterology, Kaohsiung Medical University, Kaohsiung
| | - I-C Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung and College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Y-J Chen
- Department of Radiation Oncology, MacKay Memorial Hospital
| | - T-E Wang
- Division of Gastroenterology, Kaohsiung Medical University, Kaohsiung
| | - Y-F Chang
- Division of Hematology and Oncology, Department of Internal Medicine
| | - C-L Yang
- Department of Dietetics and Nutrition, Taipei Veterans General Hospital
| | - W-C Huang
- Division of Thoracic Surgery, Department of Surgery, MacKay Memorial Hospital and MacKay Medical College
| | - W-K Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - B-S Sheu
- Departments of Institute of Clinical Medicine and Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - M-S Wu
- Department of Internal Medicine, National Taiwan University Hospital, Kaohsiung Medical University, Kaohsiung
| | - J-T Lin
- School of Medicine, Fu Jen Catholic University, Taipei, Kaohsiung Medical University, Kaohsiung
| | - C-H Chu
- Division of Gastroenterology, Kaohsiung Medical University, Kaohsiung
| |
Collapse
|
|
36
|
Berkelmans GHK, Fransen L, Weijs TJ, Lubbers M, Nieuwenhuijzen GAP, Ruurda JP, Kouwenhoven EA, van Det MJ, Rosman C, van Hillegersberg R, Luyer MDP. The long-term effects of early oral feeding following minimal invasive esophagectomy. Dis Esophagus 2018; 31:1-8. [PMID: 29025081 DOI: 10.1093/dote/dox114] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A nil-by-mouth regime with enteral nutrition via an artificial route is frequently applied following esophagectomy. However, early initiation of oral feeding could potentially improve recovery and has shown to be beneficial in many types of abdominal surgery. Although short-term nutritional safety of oral intake after an esophagectomy has been documented, long-term effects of this feeding regimen are unknown. In this cohort study, data from patients undergoing minimal invasive Ivor-Lewis esophagectomy between 04-2012 and 09-2015 in three centers in Netherlands were collected. Patients in the oral feeding group were retrieved from a previous prospective study and compared with a cohort of patients with early enteral jejunostomy feeding but delayed oral intake. Body mass index (BMI) measurements, complications, and nutritional re-interventions (re- or start of artificial feeding, start of total parenteral nutrition) were gathered over the course of one year after surgery. One year after surgery the median BMI was 22.8 kg/m2 and weight loss was 7.0 kg (9.5%) in 114 patients. Patients in the early oral feeding group lost more weight during the first postoperative month (P = 0.004). However, in the months thereafter this difference was not observed anymore. In the early oral feeding group, 28 patients (56%) required a nutritional re-intervention, compared to 46 patients (72%) in the delayed oral feeding group (P = 0.078). During admission, more re-interventions were performed in the delayed oral feeding group (17 vs. 46 patients P < 0.001). Esophagectomy reduces BMI in the first year after surgery regardless of the feeding regimen. Direct start of oral intake following esophagectomy has no impact on early nutritional re-interventions and long-term weight loss.
Collapse
Affiliation(s)
| | - L Fransen
- Department of Surgery Catharina Hospital, Eindhoven
| | - T J Weijs
- Department of Surgery, University Medical Center, Utrecht
| | - M Lubbers
- Department of Surgery, Ziekenhuisgroep Twente, Almelo
| | | | - J P Ruurda
- Department of Surgery, University Medical Center, Utrecht
| | | | - M J van Det
- Department of Surgery, Ziekenhuisgroep Twente, Almelo
| | - C Rosman
- Department of Surgery, University Medical Center Radboud, Nijmegen, The Netherlands
| | | | - M D P Luyer
- Department of Surgery Catharina Hospital, Eindhoven
| |
Collapse
|
|
37
|
Does Prolonged Enteral Feeding With Supplemental Omega-3 Fatty Acids Impact on Recovery Post-esophagectomy. Ann Surg 2017; 266:720-728. [DOI: 10.1097/sla.0000000000002390] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
|
38
|
Donohoe CL, Healy LA, Fanning M, Doyle SL, Hugh AM, Moore J, Ravi N, Reynolds JV. Impact of supplemental home enteral feeding postesophagectomy on nutrition, body composition, quality of life, and patient satisfaction. Dis Esophagus 2017; 30:1-9. [PMID: 28859364 DOI: 10.1093/dote/dox063] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Indexed: 12/11/2022]
Abstract
The aim of this prospective cohort study is to analyze the impact of supplemental home enteral nutrition (HEN) post-esophageal cancer surgery on nutritional parameters, quality of life (QL), and patient satisfaction. A systematic review reported that over 60% of patients lose >10% of both body weight and BMI by 6 months after esophagectomy. Enteral feeding (EF) is increasingly a modern standard postoperatively; however, the impact of extended HEN postdischarge has not been systematically studied. One hundred forty-nine consecutive patients [mean age 62 ± 9, 80% male,76% adenocarcinoma, 66% on multimodal protocols, and 69% with BMI ≥ 25 kg/m2] were studied. Jejunal EF commenced day 1 postoperatively, and supplemental overnight HEN (764 kcal; 32g protein) continued on discharge for a planned further 4 weeks. Weight, BMI, and body composition analysis (bioimpedance analysis) were measured at baseline, preoperatively and at 1, 3, and 6 months, along with the EORTC QLQ-C30/OES18 QL measures. A patient satisfaction questionnaire addressed eight key items in relation to HEN (max score 100/item). Median (range) total duration of EF was 49 days (28-96). Overall compliance was 96%. At 6 months, compared with preoperatively, 58 (39%) patients lost >10% weight, with median (IQR) loss of 6.8 (4-9) kg, and 62 (41%) patients lost >10% BMI. Lean body mass and body fat were significantly (p < 0.001) decreased. Mean global QL decreased (p < 0.01) from 82 to 72. A high mean satisfaction score (>70 ± 11/100) was reported, >80 for practical training, activities of daily living, pain, anxiety, recovery and impact on caregivers, with lower scores for appetite (33 ± 24) and sleep (63 ± 30). Supplemental HEN for a minimum of one month postdischarge is associated with high compliance and patient satisfaction. Weight and BMI loss may still be substantial, however this may be less than published literature, in addition the impact on HR-QL may be attenuated. HEN has both subjective and objective rationale and merits further validation toward optimizing nutritional recovery and overall wellbeing.
Collapse
Affiliation(s)
| | - L A Healy
- Clinical Nutrition, St. James's Hospital and Trinity College Dublin
| | - M Fanning
- Clinical Nutrition, St. James's Hospital and Trinity College Dublin
| | - S L Doyle
- Department of Surgery.,School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - A Mc Hugh
- Clinical Nutrition, St. James's Hospital and Trinity College Dublin
| | | | | | | |
Collapse
|
|
39
|
Dalton BGA, Friedant AJ, Su S, Schatz TAP, Ruth KJ, Scott WJ. Benefits of Supplemental Jejunostomy Tube Feeding During Neoadjuvant Therapy in Patients with Locally Advanced, Potentially Resectable Esophageal Cancer. J Laparoendosc Adv Surg Tech A 2017; 27:1279-1283. [PMID: 28777676 DOI: 10.1089/lap.2017.0320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Standard treatment for locally advanced esophageal cancer includes neoadjuvant therapy followed by surgical resection. However, many patients experience a period of decreased oral intake during neoadjuvant treatment and are at risk for malnutrition. We hypothesize that use of jejunostomy tube (j-tube) feedings during neoadjuvant therapy in selected patients may be associated with better perioperative outcomes. METHODS A prospectively collected database at a single institution was retrospectively analyzed. The study period was from 2005 to 2015. Patients who underwent j-tube placement before neoadjuvant therapy before definitive resection for esophageal cancer were included in the analysis. Perioperative outcomes were compared between patients who adhered to recommended tube feeds during neoadjuvant therapy (users) and patients who did not adhere (nonusers). RESULTS During the study period, 94/301 patients received a j-tube before or during neoadjuvant therapy for esophageal cancer. Seventy-three patients utilized tube feeds regularly during the neoadjuvant phase, while 21 patients did not. The groups did not differ significantly with respect to clinical factors such as dysphagia on presentation, postneoadjuvant therapy performance status, or Charlson Comorbidity Index. Perioperative pneumonia rates were lower in j-tube users compared to nonusers (6.8% [5 of 73] versus 23.8% [5 of 21]), respectively, P = .036); this difference remained significant with adjustment for type of surgery (odds ratio = 0.16, P = .018). CONCLUSIONS j-Tube users had a significantly lower incidence of pneumonia within 30 days of curative resection when compared to nonusers. j-Tube feedings during neoadjuvant therapy for selected patients with locally advanced esophageal cancer should be encouraged.
Collapse
Affiliation(s)
| | | | - Stacey Su
- Fox Chase Cancer Center , Philadelphia, Pennsylvania
| | | | - Karen J Ruth
- Fox Chase Cancer Center , Philadelphia, Pennsylvania
| | | |
Collapse
|
|
40
|
Weijs TJ, van Eden HWJ, Ruurda JP, Luyer MDP, Steenhagen E, Nieuwenhuijzen GAP, van Hillegersberg R. Routine jejunostomy tube feeding following esophagectomy. J Thorac Dis 2017; 9:S851-S860. [PMID: 28815083 DOI: 10.21037/jtd.2017.06.73] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Malnutrition is an important problem following esophagectomy. A surgically placed jejunostomy secures an enteral feeding route, facilitating discharge with home-tube feeding and long-term nutritional support. However, specific complications occur, and data are lacking that support its use over other enteral feeding routes. Therefore routine jejunostomy tube feeding and discharge with home-tube feeding was evaluated, with emphasis on weight loss, length of stay and re-admissions. METHODS Consecutive patients undergoing esophagectomy for cancer, with gastric tube reconstruction and jejunostomy creation, were analyzed. Two different regimens were compared. Before January 07, 2011 patients were discharged when oral intake was sufficient, without tube feeding. After that discharge with home-tube feeding was routinely performed. Logistic regression analysis corrected for confounders. RESULTS Some 236 patients were included. The median duration of tube feeding was 35 days. Reoperation for a jejunostomy-related complication was needed in 2%. The median body mass index (BMI) remained stable during tube feeding. The BMI decreased significantly after stopping tube feeding: from 25.6 (1st-3rd quartile 23.0-28.6) kg/m2 to 24.4 (22.0-27.1) kg/m2 at 30 days later [median weight loss: 3.0 (1.0-5.3) kg; 3.9% (1.5-6.3%)]. Weight loss was not affected by the duration of tube feeding duration. Routine home-tube feeding did not affect weight loss, admission time or the readmission rate. CONCLUSIONS Weight loss following esophagectomy occurs once that tube feeding is stopped, independently from the time interval after esophagectomy. Moreover routine discharge with home-tube feeding does not reduce length of stay or readmissions. These findings question the value of routine jejunostomy placement and emphasize the need for further research.
Collapse
Affiliation(s)
- Teus J Weijs
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hanneke W J van Eden
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Elles Steenhagen
- Division of Internal Medicine and Dermatology, Department of Dietetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | |
Collapse
|
|
41
|
|
|
42
|
Nutrient intake and contribution of home enteral nutrition to meeting nutritional requirements after oesophagectomy and total gastrectomy. Eur J Clin Nutr 2017; 71:1121-1128. [PMID: 28656968 DOI: 10.1038/ejcn.2017.88] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 01/29/2017] [Accepted: 04/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES This study evaluated nutrition after oesophago-gastric resection and the influence of home jejunostomy feeding in the six months after surgery. SUBJECTS/METHODS Data on nutritional intake and physiologic measures were collected as part of a randomised trial with measurements taken before and up to six months after surgery. RESULTS A total of 41 participants (32 oesophagectomy, 9 total gastrectomy) received home jejunostomy feeding (n=18) or usual care without feeding (n=23). At hospital discharge, oral intakes were adequate for energy and protein in 9% and 6%, respectively. By three and six months, these values had increased to 61% and 55%, 94% and 77% respectively. Six participants (26%) who received usual care required rescue feeding. Six weeks after hospital discharge, energy intakes were met in those who received jejunal feeding because of the contribution of enteral nutrition. Jejunal feeding did not affect oral intake, being similar in both groups (fed: 77% estimated need, usual care: 79%). At three months, inadequate micronutrient intakes were seen in over one third. Compared to baseline values, six weeks after surgery, weight loss exceeding 5% was seen in 5/18 (28%) who received feeding, 14/17 (82%) who received usual care and 5/6 (83%) of those who required rescue feeding, P=0.002. Weight loss averaged 4.1% (fed), 10.4% (usual care) and 9.2% (rescue fed), P=0.004. These trends persisted out to six months. CONCLUSIONS Supplementary jejunostomy feeding made an important contribution to meeting nutrition after oesophago-gastric resection. Importantly, oral nutritional intake was not compromised dispelling the assertion that jejunal feeding deincentivises patients from eating.
Collapse
|
|
43
|
Blakely AM, Ajmal S, Sargent RE, Ng TT, Miner TJ. Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies. World J Gastrointest Surg 2017; 9:53-60. [PMID: 28289510 PMCID: PMC5329704 DOI: 10.4240/wjgs.v9.i2.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/09/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess nutritional recovery, particularly regarding feeding jejunostomy tube (FJT) utilization, following upper gastrointestinal resection for malignancy.
METHODS A retrospective review was performed of a prospectively-maintained database of adult patients who underwent esophagectomy or gastrectomy (subtotal or total) for cancer with curative intent, from January 2001 to June 2014. Patient demographics, the approach to esophagectomy, the extent of gastrectomy, FJT placement and utilization at discharge, administration of parenteral nutrition (PN), and complications were evaluated. All patients were followed for at least ninety days or until death.
RESULTS The 287 patients underwent upper GI resection, comprised of 182 esophagectomy (n = 107 transhiatal, 58.7%; n = 56 Ivor-Lewis, 30.7%) and 105 gastrectomy [n = 63 subtotal (SG), 60.0%; n = 42 total (TG), 40.0%]. 181 of 182 esophagectomy patients underwent FJT, compared with 47 of 105 gastrectomy patients (99.5% vs 44.8%, P < 0.0001), of whom most had undergone TG (n = 39, 92.9% vs n = 8 SG, 12.9%, P < 0.0001). Median length of stay was similar between esophagectomy and gastrectomy groups (14.7 d vs 17.1 d, P = 0.076). Upon discharge, 87 esophagectomy patients (48.1%) were taking enteral feeds, with 53 (29.3%) fully and 34 (18.8%) partially dependent. Meanwhile, 20 of 39 TG patients (51.3%) were either fully (n = 3, 7.7%) or partially (n = 17, 43.6%) dependent on tube feeds, compared with 5 of 8 SG patients (10.6%), all of whom were partially dependent. Gastrectomy patients were significantly less likely to be fully dependent on tube feeds at discharge compared to esophagectomy patients (6.4% vs 29.3%, P = 0.0006). PN was administered despite FJT placement more often following gastrectomy than esophagectomy (n = 11, 23.4% vs n = 7, 3.9%, P = 0.0001). FJT-specific complications requiring reoperation within 30 d of resection occurred more commonly in the gastrectomy group (n = 6), all after TG, compared to 1 esophagectomy patient (12.8% vs 0.6%, P = 0.0003). Six of 7 patients (85.7%) who experienced tube-related complications required PN.
CONCLUSION Nutritional recovery following esophagectomy and gastrectomy is distinct. Operations are associated with unique complication profiles. Nutritional supplementation alternative to jejunostomy should be considered in particular scenarios.
Collapse
|
|
44
|
Konosu M, Iwaya T, Kimura Y, Akiyama Y, Shioi Y, Endo F, Nitta H, Otsuka K, Koeda K, Sasaki A. Peripheral vein infusions of amino acids facilitate recovery after esophagectomy for esophageal cancer: Retrospective cohort analysis. Ann Med Surg (Lond) 2017; 14:29-35. [PMID: 28138387 PMCID: PMC5256676 DOI: 10.1016/j.amsu.2017.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 11/24/2022] Open
Abstract
Background To investigate the efficacy of amino acid administration via peripheral veins in addition to conventional enteral feeding following esophagectomy. Materials and methods Retrospective analysis of data pertaining to 33 patients with esophageal cancer who underwent radical esophagectomy and satisfied the required nutrition control. Patients were divided into the amino acid group (n = 17) and control group (n = 16). Primary outcomes were albumin (Alb) and prealbumin (PreAlb) levels, urinary 3-methylhistidine/creatinine (3-MeHis/Cre) ratios, nitrogen balance, and weight; postoperative complications were noted as secondary outcomes. Results Alb levels were significantly higher in the amino acid group on postoperative day (POD)-14 (3.4 ± 0.3 vs. 3.1 ± 0.4 mg/dL in the control group, p = 0.018) and at 1 month after surgery (3.8 ± 0.4 vs. 3.5 ± 0.3 mg/dL, p = 0.045). No significant differences were observed in PreAlb and urinary 3-MeHis/Cre rates between the treatment groups. Body weights at 3 months postoperatively were decreased by 6% and 3% in the control and amino acid groups, respectively. Conclusion Peripheral venous administration of amino acids soon after surgical stress is an effective method for nutritional control.
Radical resection for esophageal cancer is a highly invasive procedure. Enteral feeding has been used in postoperative period for esophagectomy. Peripheral vein infusion of amino acids is effective for post esophagectomy.
Collapse
Affiliation(s)
- Masafumi Konosu
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Takeshi Iwaya
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Yusuke Kimura
- Department of Palliative Care Medicine, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Yuji Akiyama
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Yoshihiro Shioi
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Fumitaka Endo
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Koki Otsuka
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Keisuke Koeda
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| |
Collapse
|
|
45
|
Mak M, Bell K, Ng W, Lee M. Nutritional status, management and clinical outcomes in patients with esophageal and gastro-oesophageal cancers: A descriptive study. Nutr Diet 2016; 74:229-235. [PMID: 28731604 DOI: 10.1111/1747-0080.12306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 05/21/2016] [Accepted: 06/13/2016] [Indexed: 12/30/2022]
Abstract
AIM The aims of this study were to investigate the nutritional management practice and nutritional status of patients with oesophageal and gastro-oesophageal cancers, and to propose strategies for improving their nutritional and clinical outcomes. METHODS All patients diagnosed with oesophageal and gastro-oesophageal cancers and treated with chemotherapy and/or radiotherapy at the Liverpool Cancer Therapy Centre (between August 2010 and February 2014) were included in this retrospective study. Patient and tumour characteristics, nutritional status and management were compared to clinical outcomes. RESULTS A total of 69 patients met the inclusion criteria. The median weight loss prior to treatment commencement was 10.5% (Interquartile Range (IQR) = 6.6-15.4). A decline in nutritional status continued throughout the treatment course. The median percentage of weight loss during treatment was 3.53% (IQR = 0.00-6.84). Seven and 19 patients required nutrition intervention using a feeding tube or stent insertion to manage dysphagia, respectively. In patients treated with a curative intent, radiotherapy was completed in 100% of those with a nasogastric tube insertion as compared to 80% who had a stent insertion. There was a higher percentage of patients from culturally and linguistically diverse (CALD) background, experiencing significant weight loss when compared with their non-CALD counterparts (P = 0.04). CONCLUSIONS Patients with oesophageal and gastro-oesophageal cancers commonly present with significant weight loss and this continues during the course of their anti-cancer treatment. A standardised protocol of nutrition management for these cancer patients is recommended, focusing on assisting patients from CALD backgrounds.
Collapse
Affiliation(s)
- May Mak
- Dietetics Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Katherine Bell
- Dietetics Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Weng Ng
- Department of Medical Oncology, Liverpool Cancer Therapy Centre, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Liverpool, New South Wales, Australia
| | - Mark Lee
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
|
46
|
Weimann A, Gockel I, Hölscher AH, Meyer HJ. [Impact of perioperative nutritional therapy on risk and complication management in patients undergoing esophagectomy for cancer]. Chirurg 2016; 87:1046-1053. [PMID: 27492377 DOI: 10.1007/s00104-016-0256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Esophagectomy is considered to be a high risk procedure regarding postoperative morbidity and mortality. Therefore, in Germany, these operations are limited to hospitals fulfilling a minimum quantity. This systematic review focuses on risk and complication management regarding the impact of perioperative nutritional therapy, including the recent S3-guideline recommendations and comments of the German Working Group of Medical Societies (AWMF) which were established with contributions from the authors.
Collapse
Affiliation(s)
- A Weimann
- Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129, Leipzig, Deutschland.
| | - I Gockel
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A H Hölscher
- Zentrum für Speiseröhren- und Magenchirurgie, Agaplesion Markuskrankenhaus Frankfurt, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Deutschland
| | - H-J Meyer
- Deutsche Gesellschaft für Chirurgie e. V., Luisenstr. 58/59, 10117, Berlin, Deutschland
| |
Collapse
|
|
47
|
Elshaer M, Gravante G, White J, Livingstone J, Riaz A, Al-Bahrani A. Routes of early enteral nutrition following oesophagectomy. Ann R Coll Surg Engl 2016; 98:461-7. [PMID: 27388543 DOI: 10.1308/rcsann.2016.0198] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction Oesophagectomy for cancer is a challenging procedure with a five-year overall survival rate of 15-20%. Early enteral nutrition following oesophagectomy is a crucial component of the postoperative recovery and carries a significant impact on the outcome. Different methods of enteral feeding were conducted in our unit. The aim of this study was to examine the efficacy and safety of nasojejunal tube (NJT), jejunostomy tube (JT) and pharyngostomy tube (PT) feeding after oesophagectomy. Methods A retrospective review was carried out of prospectively collected data on patients with oesophageal cancer who underwent an oesophagectomy between 2011 and 2014. The primary outcome was feeding tube related complications such as occlusion, dislocation and leak. The secondary outcomes were length of stay and 30-day morbidity. Results A total of 90 oesophagectomies were included in the study. A NJT was inserted in 41 patients (45.6%), a JT was used in 14 patients (15.5%) and a PT was the route for enteral nutrition in 35 patients (38.9%). In total, five patients (5.5%) developed tube related complications. There were no tube related complications in the NJT group but one JT patient (7.1%) developed tube related cellulitis (p=0.189) and four PT patients (11.4%) developed tube related haemorrhage (p=0.544), tube dislocation (p=0.544) or cellulitis (p=0.189). The median length of stay and 30-day postoperative morbidity were similar between the groups. Conclusions NJT feeding is a less invasive, feasible route for early enteral nutrition following oesophagectomy. A randomised controlled trial is recommended to verify these findings.
Collapse
Affiliation(s)
- M Elshaer
- West Hertfordshire Hospitals NHS Trust , UK
| | - G Gravante
- University Hospitals of Leicester NHS Trust , UK
| | - J White
- West Hertfordshire Hospitals NHS Trust , UK
| | | | - A Riaz
- West Hertfordshire Hospitals NHS Trust , UK
| | | |
Collapse
|
|
48
|
Peng J, Cai J, Niu ZX, Chen LQ. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis. Dis Esophagus 2016; 29:333-41. [PMID: 25721689 DOI: 10.1111/dote.12337] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta-analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta-analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed- and random-effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22-0.62, P = 0.00, test for heterogeneity: I(2) = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22-0.96, P = 0.04, test for heterogeneity: I(2) = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47-3.21, P = 0.01, test for heterogeneity: I(2) = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63-22.29, P = 0.01, test for heterogeneity: I(2) = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79-2.13, P = 0.30, test for heterogeneity: I(2) = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support.
Collapse
Affiliation(s)
- J Peng
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - J Cai
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Z-X Niu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - L-Q Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
|
49
|
Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc 2016; 75:199-211. [PMID: 26786393 DOI: 10.1017/s002966511500419x] [Citation(s) in RCA: 344] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.
Collapse
|
|
50
|
Gohel TD, Kirby DF. Access and Complications of Enteral Nutrition Support for Critically Ill Patients. NUTRITION SUPPORT FOR THE CRITICALLY ILL 2016:63-79. [DOI: 10.1007/978-3-319-21831-1_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
|