PS01.170: IMPACT OF MUSCLE MASS, NUTRITIONAL STATUS AND MUSCLE STRENGTH ON OUTCOMES FOLLOWING SURGERY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 97-97
Author(s):  
Eliza Hagens ◽  
Minke Feenstra ◽  
Mark I Van Berge Henegouwen ◽  
Suzanne Gisbertz
Keyword(s):  
Skeletal Muscle ◽  
Overall Survival ◽  
Esophageal Cancer ◽  
Muscle Strength ◽  
Nutritional Status ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Surface Area ◽  
Muscle Function ◽  
Skeletal Muscle Index

Abstract Background Muscle function loss and loss of skeletal muscle have been associated with worse outcomes following surgery for malignancies of gastrointestinal origin. The influence on post-operative outcomes and survival after esophageal surgery remains unclear. Primary objectives of this study were to evaluate the incidence of sarcopenia and malnutrition and to evaluate the influence of skeletal muscle surface area and muscle strength on postoperative outcomes and overall survival in esophageal cancer patients. Methods A retrospective cohort study from a prospective database was conducted in patients with resectable esophageal cancer who underwent curative-intent treatment between January 2011 and January 2016. Skeletal muscle surface area was calculated with CT scans at L3 level and corrected for height and weight before start of treatment and in the interval between neoadjuvant treatment and surgery. Muscle strength was evaluated with various tests on muscle functions and lung function tests. Nutritional status was evaluated using BMI. Results 273 Patients were included. There were 4 patients with sarcopenia before neoadjuvant therapy and only one patient with sarcopenia after completion of neoadjuvant therapy. Median skeletal muscle surface area was 78cm2/m2 for men and 61cm2/m2 for woman. Table 1 shows skeletal muscle surface area, muscle strength and BMI in relation to no, minor or major complications. Muscle strength and nutritional status did not have a significant influence on postoperative complications and overall survival. Conclusion Sarcopenia did not occur frequently in this cohort with potentially curable esophageal cancer patients. Muscle function, skeletal muscle index and BMI did not statistically influence post-operative complications or survival. Disclosure All authors have declared no conflicts of interest.

scholarly journals Effect of Postoperative Oral Intake Status on Sarcopenia Six Months After Esophageal Cancer Surgery

2021 ◽  
Author(s):  
Nanako Hijikata ◽  
Aiko Ishikawa ◽  
Satoru Matsuda ◽  
Michiyuki Kawakami ◽  
Kaori Muraoka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Nutritional Status ◽  
Handgrip Strength ◽  
Tube Feeding ◽  
Multivariate Logistic Regression Analysis ◽  
Oral Intake ◽  
Skeletal Muscle Index ◽  
Swallowing Assessment

Abstract Purpose: In patients with esophageal cancer, skeletal muscle mass has been reported to decrease progressively after surgery and be independently associated with a poor prognosis. The purpose of this study was to investigate perioperative changes in dysphagia, oral intake status, and nutritional status and identify factors related to sarcopenia six months after esophagectomy.Methods: A total of 134 patients who underwent radical resection for thoracic esophageal cancer between March 2016 and July 2019 were analyzed retrospectively. The diagnosis of sarcopenia was made by CT taken six months postoperatively using the cut-off criteria of skeletal muscle index (SMI) <52.4 cm2/m2 for male and SMI <38.5 cm2/m2 for female patients. As factors related to postoperative sarcopenia, dysphagia, oral intake status, nutritional status, and physical function were extracted from the medical records. Multivariate logistic regression analysis was performed to identify perioperative risk factors related to sarcopenia six months after surgery.Results: Of the 134 patients, 34.3% were judged to be unable to start oral intake on swallowing assessment. At discharge, 30.6% received tube feeding with or without oral intake. In the non-oral intake group on swallowing assessment, a significantly higher proportion of patients received tube feeding at discharge (p=0.014). Preoperative BMI, postoperative handgrip strength, and tube feeding at discharge were independent risk factors for sarcopenia six months after esophagectomy in male patients.Conclusions: Oral intake status at discharge is significantly related to postoperative sarcopenia in patients with esophageal cancer. Identifying high-risk groups might allow early detection of malnutrition and provision of appropriate care.

scholarly journals The Influence of Pretherapeutic and Preoperative Sarcopenia on Short-Term Outcome after Esophagectomy

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3409
Author(s):  
Johanna Grün ◽  
Lea Elfinger ◽  
Han Le ◽  
Christel Weiß ◽  
Mirko Otto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Nutritional Status ◽  
Cancer Patients ◽  
Postoperative Morbidity ◽  
Neoadjuvant Treatment ◽  
Postoperative Outcome ◽  
Morbidity And Mortality ◽  
Short Term ◽  
Term Outcome ◽  
Skeletal Muscle Index

By introducing minimally invasive surgery the rate of postoperative morbidity in esophageal cancer patients could be reduced. But esophagectomy is still associated with a relevant risk of postoperative morbidity and mortality. Patients often present with nutritional deficiency and sarcopenia even at time of diagnosis. This study focuses on the influence of skeletal muscle index (SMI) on postoperative morbidity and mortality. Fifty-two patients were included in this study. SMI was measured using computer tomographic images at the time of diagnosis and before surgery. Then, SMI and different clinicopathological and demographic features were correlated with postoperative morbidity. There was no correlation between SMI before neoadjuvant therapy (p = 0.5365) nor before surgery (p = 0.3530) with the short-term postoperative outcome. Regarding cholesterol level before surgery there was a trend for a higher risk of complications with lower cholesterol levels (p = 0.0846). Our findings suggest that a low preoperative SMI does not necessarily predict a poor postoperative outcome in esophageal cancer patients after esophagectomy but that there are many factors that influence the nutritional status of cancer patients. To improve nutritional status, cancer patients at our clinic receive specialized nutritional counselling during neoadjuvant treatment as well as after surgery.

Is neoadjuvant therapy beneficial in clinically staged T2N0 esophageal cancer?

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 135-135
Author(s):  
Taranjeet Kaur ◽  
James P. Dolan ◽  
Brian S. Diggs ◽  
Renato Luna ◽  
Brett C. Sheppard ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Clinical Stage ◽  
Cancer Center ◽  
Support Design ◽  
Node Negative ◽  
Invasive Esophagectomy ◽  
The Impact

135 Background: The optimal treatment strategy for clinical stage T2N0 (cT2N0) esophageal cancer is poorly defined. The specific aims of this analysis were to determine the impact of neoadjuvant therapy (NAT) in cT2N0 esophageal cancer patients on overall survival, nodal metastasis, staging, and pathological complete responders (pCR) NAT. Methods: We reviewed a retrospective cohort of 27 patients with cT2N0 esophageal cancer at Oregon Health & Science University, an NCI-Designated Cancer Center from 1999 to 2011. All patients were staged pre-operatively using Endoscopic Ultrasound (EUS), CT +/- FDG-PET. Patients were identified into two cohorts: NAT followed by surgery and surgery alone. We compared overall survival between the cohorts using Kaplan-Meier analysis. Results: Eleven patients (41%) received NAT followed by surgery and sixteen patients (59%) underwent surgery alone. Minimal invasive esophagectomy and decreased length of stay (p < 0.05) were associated with the presence of neoadjuvant therapy. The difference in overall survival rate was not statistically significant between NAT and surgery alone groups (p = 0.96). Three of 11 patients (27%) had a pCR and 8 (73%) were partial or non responders after NAT. In the surgery only group, nine of 16 patients (56%) were understaged, 6 (38%) were overstaged and 1 (6%) was correctly staged. Despite being clinically node negative, 14/27 (52%) had node positive disease in both groups with 5/11 (45%) in NAT group and 9/16 (56%) in surgery group. Conclusions: The benefit of NAT in cT2N0 esophageal cancer patients remains unclear. However, our finding of significant clinical understaging and frequent positive nodes in clinically node negative patients suggests a clinical benefit to NAT for some cT2N0 patients before surgery. These observations support design of a prospective clinical trial to define the role of NAT in patients with cT2N0 esophageal cancer.

scholarly journals Gait disturbances and muscle dysfunction in fibroblast growth factor 2 knockout mice

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
C. Homer-Bouthiette ◽  
L. Xiao ◽  
Marja M. Hurley
Keyword(s):  
Skeletal Muscle ◽  
Growth Factor ◽  
Muscle Strength ◽  
Fibroblast Growth Factor ◽  
Muscle Function ◽  
Fibroblast Growth Factor 2 ◽  
Fibroblast Growth ◽  
Skeletal Muscle Function ◽  
Age Related ◽  
Gait Disturbances

AbstractFibroblast growth factor 2 (FGF2) is important in musculoskeletal homeostasis, therefore the impact of reduction or Fgf2 knockout on skeletal muscle function and phenotype was determined. Gait analysis as well as muscle strength testing in young and old WT and Fgf2KO demonstrated age-related gait disturbances and reduction in muscle strength that were exacerbated in the KO condition. Fgf2 mRNA and protein were significantly decreased in skeletal muscle of old WT compared with young WT. Muscle fiber cross-sectional area was significantly reduced with increased fibrosis and inflammatory infiltrates in old WT and Fgf2KO vs. young WT. Inflammatory cells were further significantly increased in old Fgf2KO compared with old WT. Lipid-related genes and intramuscular fat was increased in old WT and old Fgf2KO with a further increase in fibro-adipocytes in old Fgf2KO compared with old WT. Impaired FGF signaling including Increased β-Klotho, Fgf21 mRNA, FGF21 protein, phosphorylated FGF receptors 1 and 3, was observed in old WT and old Fgf2KO. MAPK/ ERK1/2 was significantly increased in young and old Fgf2KO. We conclude that Fgf2KO, age-related decreased FGF2 in WT mice, and increased FGF21 in the setting of impaired Fgf2 expression likely contribute to impaired skeletal muscle function and sarcopenia in mice.

scholarly journals The Influence of Body Composition on the Systemic Exposure of Paclitaxel in Esophageal Cancer Patients

2021 ◽  
Vol 14 (1) ◽  
pp. 47
Author(s):  
Leni van Doorn ◽  
Marie-Rose B. S. Crombag ◽  
Hánah N. Rier ◽  
Jeroen L. A. van Vugt ◽  
Charlotte van Kesteren ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Body Composition ◽  
Dose Range ◽  
Systemic Exposure ◽  
Lumbar Vertebra ◽  
Skeletal Muscle Index ◽  
Mixed Effects Modeling ◽  
Significance Threshold ◽  
A Prospective Study

Changes in body composition are associated with chemotherapy-related toxicities and effectiveness of treatment. It is hypothesized that the pharmacokinetics (PK) of chemotherapeutics may depend on body composition. The effects of body composition on the variability of paclitaxel PK were studied in patients with esophageal cancer. Skeletal muscle index (SMI), visceral adipose tissue (VAT), and skeletal muscle density (SMD) were measured at the third lumbar vertebra on computed tomography (CT) scans performed before treatment. Paclitaxel PK data were collected from a prospective study performed between May 2004 and January 2014. Non-linear mixed-effects modeling was used to fit paclitaxel PK profiles and evaluate the covariates body surface area (BSA), SMI, VAT, and SMD using a significance threshold of p < 0.001. Paclitaxel was administered to 184 patients in a dose range of 50 to 175 mg/m2. Median BSA was 1.98 m2 (range of 1.4 to 2.8 m2). SMI, VAT, and SMD were not superior to BSA in predicting paclitaxel PK. The additive value of SMI, VAT, and SMD to BSA was also negligible. We did not find evidence that paclitaxel dosing could be further optimized by correcting for SMI, VAT, or SMD.

Enteral Access is not Required for Esophageal Cancer Patients Undergoing Neoadjuvant Therapy

2016 ◽  
Vol 102 (3) ◽  
pp. 948-954 ◽  
Author(s):  
Mary E. Huerter ◽  
Eric J. Charles ◽  
Emily A. Downs ◽  
Yinin Hu ◽  
Christine L. Lau ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Enteral Access

563 VARIATION IN TREATMENT PATTERNS AND OUTCOMES FOR RESECTED ESOPHAGEAL CANCER AT DESIGNATED THORACIC SURGERY CENTERS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Vaibhav Gupta ◽  
Jordan Levy ◽  
Biniam Kidane ◽  
Alyson Mahar ◽  
Jolie Ringash ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Thoracic Surgery ◽  
Neoadjuvant Therapy ◽  
Surgical Outcomes ◽  
Postoperative Mortality ◽  
Positive Margin ◽  
Treatment Patterns ◽  
Case Mix

Abstract   Ontario defined designated thoracic surgery centres to provide high-volume care for patients undergoing esophageal cancer resection. The objective of this study was to compare thoracic centres’ performance to non-thoracic centres, and to assess variation in treatment patterns and outcomes across thoracic centres. Methods A retrospective cohort study (2002–2014) was conducted in Ontario, Canada (population 13.6 million), examining adults with resected esophageal cancer. Case mix, use of neoadjuvant therapy, surgical outcomes (lymph node yield and positive margin rates) and survival were described across the 15 thoracic centres. Multivariable regression was used to estimate the effect of having surgery at designated thoracic centres on postoperative (in-hospital & 90-day post-discharge) mortality and overall survival, adjusting for case mix. Results Of 3,880 patients meeting study criteria, 2,213 had pathology data available and were included in the analysis. Average age was 64 years, 85.7% had adenocarcinoma, 50.2% were pT3, and 38.4% were pN0. Patients at thoracic centres (82.6%) received more neoadjuvant therapy, but there was no difference in positive margin rates, lymph node harvest, postoperative mortality and overall survival between thoracic and non-thoracic centres. Across thoracic centres, rates of neoadjuvant therapy varied from 16.4–81.6%, positive margin rates varied from 8.2–29.6%, median lymph node harvest varied from 7–20 nodes, postoperative mortality varied from 0–18.7%, and median survival varied from 17–26 months. Conclusion There was significant variability in treatment patterns, surgical outcomes, and survival among patients treated at designated thoracic centres. Feedback of patient outcomes to surgeons and hospitals, and translating best practices from high-performing hospitals to other hospitals, is the next step in improving outcomes.

Enteral nutritional support in patients undergoing chemoradiotherapy for esophageal carcinoma

2020 ◽  
Vol 16 (35) ◽  
pp. 2949-2957
Author(s):  
Bei Wang ◽  
Xiaowen Jiang ◽  
Dalong Tian ◽  
Wei Geng
Keyword(s):  
Esophageal Cancer ◽  
High Risk ◽  
Enteral Nutrition ◽  
Nutritional Status ◽  
Cancer Patients ◽  
Nutritional Support ◽  
Nutritional Assessment ◽  
Assessment Tools ◽  
Tumor Patients ◽  
Selection Of

Esophageal cancer patients are at a high risk of malnutrition. Both the disease itself and chemoradiotherapy will lead to the deterioration of nutritional status. The development of nutritional oncology promotes the application of enteral nutrition in tumor patients. Through nutritional support, prognosis is improved and the incidence of adverse chemoradiotherapy reactions is reduced, especially in those with head and neck or esophageal cancer. This review summarizes enteral nutritional support in esophageal cancer patients undergoing chemoradiotherapy in recent years, including a selection of nutritional assessment tools, the causes and consequences of malnutrition in esophageal cancer patients, types of access and effects of enteral nutrition. More patients with esophageal cancer will benefit from the development of enteral nutrition technology in the future.

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