Severe weight loss after minimally invasive oesophagectomy is associated with poor survival in patients with oesophageal
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RESEARCH ARTICLE
Open Access
Severe weight loss after minimally invasive oesophagectomy is associated with poor survival in patients with oesophageal cancer at 5 years Yasufumi Koterazawa*, Taro Oshikiri, Gosuke Takiguchi, Naoki Urakawa, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Tetsu Nakamura, Satoshi Suzuki and Yoshihiro Kakeji
Abstract Background: Patients often experience severe weight loss after oesophagectomy. Enteral nutrition via a feeding jejunostomy tube (FT) is commonly practised. This study aimed to assess the effect of severe weight loss postoperatively and enteral nutrition via an FT on long-term prognosis after oesophagectomy. Methods: This study analysed 317 patients who underwent minimally invasive oesophagectomy at Kobe University Hospital and Hyogo Cancer Center from 2010 to 2015. The patients’ body weight was evaluated at 3 months postoperatively. They were organised into the severe weight loss (n = 65) and moderate weight loss (n = 252) groups. Furthermore, they were categorised into the FT group (184 patients who had an FT placed during oesophagectomy) and no-FT group (133 patients without FT). Patients (119 per group) matched for the FT and no-FT groups were identified via propensity score matching. Results: The 5-year overall survival (OS) rate in the severe weight loss group was significantly lower (p = 0.024). In the multivariate analysis, tumour invasion depth (pT3-4), preoperative therapy and severe weight loss had a worse OS (hazard ratio = 1.89; 95% confidence interval = 1.12–3.17, hazard ratio = 2.11; 95% confidence interval = 1.25–3.54, hazard ratio = 1.82; 95% confidence interval = 1.02–3.524, respectively). No significant differences in the number of severe weight loss patients and OS were found between the FT and no-FT groups. Conclusion: Severe weight loss is significantly associated with poor OS. In addition, enteral nutrition via an FT did not improve the severe weight loss and OS. Keywords: Severe weight loss, Minimally invasive oesophagectomy, Enteral nutrition Background Oesophageal cancer is the eighth most common cancer worldwide [1]. Oesophagectomy is one of the main procedures of treatment for oesophageal cancer; however, compared with other gastroenterological surgeries, it is *Correspondence: [email protected] Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe City, Hyogo 650‑0017, Japan
a highly invasive procedure [2]. After oesophagectomy, many patients have reduced appetite and oral intake, which lead to severe weight loss [3]. Postoperative malnutrition is associated with poor prognosis in patients with oesophageal cancer [4–6]. We recently performed minimally invasive oesophagectomy (MIO). MIO improves not only postoperative complications [7] but also postoperative nutritional status, including serum albumin levels [8], appetite, and body mass index (BMI) [9]. However, the effect of severe
© The Author(s) 2020. Open Ac
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