P117 A FAST-TRACK RECOVERY PROGRAM REDUCES POSTOPERATIVE BODY WEIGHT LOSS AND LENGTH OF HOSPITAL STAY AFTER THORACIC ESOPHAGEAL CANCER SURGERY

Abstract Background Post-operative body weight loss (BWL) of patients who underwent esophagectomy is common. One month after esophagectomy, some patients lose weight remarkably, and others not. If preoperative or operative risk factors influencing body weight loss are identified, it will be possible that nutritional intervention is given to the patient having these risk factors. Methods In our department, the dietician stays in a surgical ward for nutritional management of patients. Ninety-two patients who underwent esophagectomy for esophageal cancer in 2016 were reviewed. Pre-operative and operative factors were correlated with post-operative BWL. The cut-off value of BWL 1 month after esophagectomy was defined with 75 percentile. Results The median body weight change was -4.8% (-18.5% ∼11.7%). The patients were divided into two groups; 24 patients with ≥ 7.3% of BWL (severe BWL group) and 68 with < 7.3% of BWL (mild BWL group). Patients’ characteristics or post-operative morbidities were not statistically different in these 2 groups. The incidence of patients with reconstruction using a colon or jejunum was higher in severe BWL group. Pre-operative body weight, body mass index, and the value of prealbumin was higher in severe BWL group. On postoperative 14 day, the patients in severe BWL group were likely to have lower energy intake per kilogram of pre-operative body weight. On multivariate analysis, high body mass index [odds ratio = 5.90; 95% confidence interval (CI) = 1.03–47.8; P = 0.046], upper location of tumor [odds ratio = 3.38; 95%, CI = 1.04–11.4; P = 0.043] were independently associated with severe BWL at 1 month after surgery. Conclusion High body mass index of ≥ 25, upper location of tumor were unfavorable risk factors for weight loss 1 month after esophagectomy for esophageal cancer. Disclosure All authors have declared no conflicts of interest.

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Faculty Opinions recommendation of Ghrelin level and body weight loss after esophagectomy for esophageal cancer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13484008.14861116 ◽

2012 ◽

Author(s):

Pelayo Correa

Keyword(s):

Weight Loss ◽

Esophageal Cancer ◽

Body Weight ◽

Body Weight Loss ◽

Ghrelin Level

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Ghrelin Level and Body Weight Loss After Esophagectomy for Esophageal Cancer

Journal of Surgical Research ◽

10.1016/j.jss.2011.09.016 ◽

2012 ◽

Vol 176 (1) ◽

pp. 74-78 ◽

Cited By ~ 16

Author(s):

Tatsuya Miyazaki ◽

Naritaka Tanaka ◽

Hanako Hirai ◽

Takehiko Yokobori ◽

Akihiko Sano ◽

...

Keyword(s):

Weight Loss ◽

Esophageal Cancer ◽

Body Weight ◽

Body Weight Loss ◽

Ghrelin Level

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Ghrelin reduction after esophageal substitution and its correlation to postoperative body weight loss in esophageal cancer patients

Surgery ◽

10.1016/j.surg.2005.11.015 ◽

2006 ◽

Vol 139 (6) ◽

pp. 797-805 ◽

Cited By ~ 34

Author(s):

Y DOKI ◽

K TAKACHI ◽

O ISHIKAWA ◽

I MIYASHIRO ◽

Y SASAKI ◽

...

Keyword(s):

Weight Loss ◽

Esophageal Cancer ◽

Body Weight ◽

Cancer Patients ◽

Body Weight Loss ◽

Esophageal Substitution

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Clinical outcomes after one anastomosis gastric bypass versus sleeve gastrectomy in super-super-obese patients

Surgical Endoscopy ◽

10.1007/s00464-021-08790-7 ◽

2021 ◽

Author(s):

Sophia M.-T. Schmitz ◽

Patrick H. Alizai ◽

Andreas Kroh ◽

Sandra Schipper ◽

Jonathan F. Brozat ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Hospital Stay ◽

Perioperative Complications ◽

Liver Volume ◽

Length Of Hospital Stay ◽

Body Weight Loss ◽

One Anastomosis Gastric Bypass ◽

Super Obese

Abstract Background Bariatric surgery in super-super-obese (SSO) patients remains a continuous challenge due to intraabdominal fat masses, higher liver volume and existing comorbidities. A convenient procedure in SSO patients is one anastomosis gastric bypass (OAGB). The aim of this study was to compare the outcome of SSO patients undergoing OAGB in comparison to laparoscopic sleeve gastrectomy (LSG). Methods We retrospectively reviewed data from SSO patients who underwent OAGB and LSG in our institution between 2008 and 2020. Primary endpoints included percentage total body weight loss and percentage BMI loss at 12, 24, and 36 months after the operation. Secondary endpoints were perioperative complications, procedure length, length of hospital stay and outcome of comorbidities. Results 243 patients were included in this study. 93 patients underwent LSG and 150 underwent OAGB. At any of the time points evaluated, weight loss in patients after OAGB was greater than in LSG patients, while procedure length was significantly shorter for OAGB than LSG (81.4 vs. 92.1 min, p-value < 0.001). Additionally, mean length of hospital stay was shorter in the OAGB group (3.4 vs. 4.5 days, p-value < 0.001). There were more severe complications (Clavien-Dindo ≥ 3a) in the LSG group (11.8% vs 2.7%, p-value = 0.005). Conclusion In this retrospective analysis, OAGB was superior to LSG in terms of weight loss in SSO patients. Procedure length and hospital stay were shorter after OAGB in comparison to LSG and there were fewer severe complications. OAGB can therefore be regarded a safe and effective treatment modality for SSO patients.

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Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer

Diseases of the Esophagus ◽

10.1093/dote/doy113 ◽

2018 ◽

Vol 32 (7) ◽

Cited By ~ 3

Author(s):

F Klevebro ◽

A Johar ◽

J Lagergren ◽

P Lagergren

Keyword(s):

Weight Loss ◽

Esophageal Cancer ◽

Hospital Stay ◽

Cox Regression ◽

Gastroesophageal Junction ◽

Length Of Hospital Stay ◽

Cancer Surgery ◽

Early Enteral Nutrition ◽

Esophageal Cancer Surgery ◽

Increased Risk

SUMMARY Substantial weight loss and eating problems are common before and after esophagectomy for cancer. The use of jejunostomy might prevent postoperative weight loss, but studies evaluating other outcomes are scarce. This study aims to assess the influence of jejunostomy on postoperative health-related quality of life (HRQOL), complications, reoperation, hospital stay, and survival. This prospective and population-based cohort study included all patients operated on for esophageal or gastroesophageal junction cancer in Sweden in 2001–2005 with follow-up until 31st December 2016. Data regarding patient and tumor characteristics and treatment were prospectively collected. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), whereas Cox regression provided hazard ratios with 95% CI. All risk estimates were adjusted for age, sex, tumor histology, stage, comorbidity, surgical approach, neoadjuvant therapy, and body mass index and weight loss at baseline. Among 397 patients, 181 (46%) received a jejunostomy during surgery. The use of jejunostomy did not influence the HRQOL at 6 months or 3 years after treatment. Jejunostomy users had no statistically significantly increased risk of postoperative complications (OR 1.27; 95% CI 0.86–1.87) or reoperation (OR 1.70; 95% CI 0.88–3.28). Intensive unit care and length of hospital stay was the same independent of the use of jejunostomy. The all-cause mortality was not increased in the jejunostomy group (HR 0.89, 95% CI: 0.74–1.07). This study indicates that jejunostomy does not influence postoperative HRQOL, complications, or survival after esophageal cancer surgery, it can be considered a safe method for early enteral nutrition after esophageal cancer surgery but benefits for the patients need further investigations.

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