RA03.01: A POPULATION-BASED STUDY ON LYMPH NODE RETRIEVAL IN PATIENTS WITH ESOPHAGEAL CANCER: RESULTS FROM THE DUTCH UPPER GASTROINTESTINAL CANCER AUDIT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 22-23
Author(s):  
Leonie Van Der Werf ◽  
Johan Dikken ◽  
Mark I Van Berge Henegouwen ◽  
Valery Lemmens ◽  
Grard A P Nieuwenhuijzen ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Neoadjuvant Therapy ◽  
Hospital Volume ◽  
Conflicts Of Interest ◽  
Neoadjuvant Chemoradiotherapy ◽  
Charlson Score ◽  
Short Term ◽  
Lymph Node Retrieval

Abstract Background For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study was to analyze the number of retrieved LNs in the Netherlands, to assess factors associated with LN yield and to explore the association with short-term outcomes. Methods For this retrospective national cohort study, patients with an esophageal carcinoma who underwent esophagectomy between 2011–2016 were included. Primary outcome was the number of retrieved LNs. Associations were tested with univariable and multivariable regression analysis for the association with ≥ 15 LNs. Results 3970 patients were included. Between 2011–2016 the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71[0.57–0.88]), Charlson-score 0 (versus: Charlson-score 2: 0.76[0.63–0.92]), cN2-category (reference: cN0, 1.32[1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73[1.29–2.32], 2.15[1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46[1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29[0.23–0.36] and 0.43[0.32–0.59], hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94[1.55–2.42], 3.01[2.36–3.83]) and year of surgery (reference: 2011, ORs: 1.48, 1.53, 2.28, 2.44, 2.54). There was no association of ≥ 15 LNs with short-term outcomes. Conclusion The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN-category, neoadjuvant therapy, surgical approach, year of resection and hospital volume were all associated with increased LN yield. The retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality. Disclosure All authors have declared no conflicts of interest.

Minimally Invasive Ivor Lewis Esophagectomy after Induction Therapy Yields Similar Early Outcomes to Surgery Alone

2011 ◽  
Vol 6 (5) ◽  
pp. 331-336 ◽  
Author(s):  
Luis F. Tapias ◽  
Christopher R. Morse
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Neoadjuvant Therapy ◽  
Neoadjuvant Chemoradiotherapy ◽  
R0 Resection ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Short Term Mortality

Objective Although considered an integral part of treatment for regionally advanced esophageal cancer, there is conflicting literature regarding the effect of neoadjuvant chemoradiotherapy on esophagectomy. The objectives of this study are to examine the effect of neoadjuvant therapy in regard to perioperative parameters, morbidity, and short-term mortality in patients undergoing a minimally invasive Ivor Lewis esophagectomy (MIE). Methods This is a retrospective review of 39 patients undergoing MIE for esophageal cancer during 2007–2010. Results Of the 39 patients, 14 (36%) did not receive neoadjuvant therapy (NCR) and 25 (64%) did receive either chemoradiotherapy or chemotherapy (CR). On comparing NCR vs CR, there was no difference in operative time (361 vs 362 minutes; P = 0.94) or estimated blood loss (233 vs 190 mL; P = 0.06). All patients underwent an R0 resection, and there was no difference in the mean number of lymph nodes harvested (NCR 21.5 vs CR 21.6; P = 0.95). Both groups had mean intensive care unit stay of 1 day (P = 0.7), and there was no difference in length of stay (NCR 7.4 vs CR 8.2 days; P = 0.38). There were no deaths or anastomotic leaks in either group. The incidence of complications in the NCR group was 21% (3/14) while in the CR group was 48% (12/25). Complications were not associated with neoadjuvant therapy [CR vs NCR: odds ratio = 3.44 (0.72–16.38); P = 0.121], even after adjusting for comorbidities and age. Conclusions MIE can be performed safely following neoadjuvant therapy with similar perioperative results, morbidity, and short-term mortality when compared with MIE alone. Longer follow-up is required for oncologic validity.

PS01.220: COMPARISON OF SHORT-TERM OUTCOMES BETWEEN RAMIE AND VAMIE IN TREATMENT MIDDLE THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Yidan Lin ◽  
Hanyu Deng
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Operation Time ◽  
Short Term ◽  
Thoracic Esophageal Cancer ◽  
Comparable Rate ◽  
Invasive Esophagectomy

Abstract Background Whether robot-assisted minimally invasive esophagectomy (RAMIE) has any advantages over video-assisted minimally invasive esophagectomy (VAMIE) remains controversial. In this study, we tried to compare the short-term outcomes of RAMIE with that of VAMIE in treating middle thoracic esophageal cancer from a single medical center. Methods Consecutive patients undergoing RAMIE or VAMIE for middle thoracic esophageal cancer from April 2016 to April 2017 were prospectively included for analysis. Baseline data and pathological findings as well as short-term outcomes of these two group (RAMIE group and VAMIE group) patients were collected and compared. A total of 84 patients (RAMIE group: 42 patients, VAMIE group: 42 patients) were included for analysis. Results The baseline characteristics between the two groups were comparable. RAMIE yielded significantly larger numbers of total dissected lymph nodes (21.9 and 17.8, respectively; P = 0.042) and right recurrent laryngeal nerve (RLN) lymph nodes (2.1 and 1.2, respectively; P = 0.033) as well as abdominal lymph nodes (10.8 and 7.7, respectively; P = 0.041) than VAMIE. Even though RAMIE may consume more overall operation time, it could significant decrease total blood loss compared to VAMIE (97 and 161 ml, respectively; P = 0.015). Postoperatively, no difference of the risk of major complications or hospital stay was observed between the two groups. Conclusion RAMIE had significant advantage of lymphadenectomy especially for dissecting RLN lymph nodes over VAMIE with comparable rate of postoperative complications. Further randomized controlled trials are badly needed to confirm and update our conclusions. Disclosure All authors have declared no conflicts of interest.

P82 A PROPENSITY SCORE MATCHED COHORT STUDY TO EVALUATE THE ASSOCIATION OF LYMPH NODE RETRIEVAL WITH LONG-TERM OVERALL SURVIVAL IN PATIENTS WITH ESOPHAGEAL CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R van der Werf, Leonie ◽  
Marra, PhD Elske ◽  
S Gisbertz, PhD Suzanne ◽  
P L Wijnhoven, PhD Bas ◽  
I van Berge Henegouwen, PhD Mark
Keyword(s):  
Esophageal Cancer ◽  
Propensity Score ◽  
Neoadjuvant Chemoradiotherapy ◽  
Stage Migration ◽  
Matched Cohort ◽  
Term Survival ◽  
Node Negative ◽  
Pathological Staging ◽  
Lymph Node Retrieval

Abstract Introduction Previous studies evaluating the association of LN yield and survival presented conflicting results and many may be influenced by confounding and stage migration. This study aimed to evaluate whether the quality indicator ‘retrieval of at least 15 lymph nodes (LNs)’ is associated with better long-term survival and more accurate pathological staging in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy and resection. Methods Data of esophageal cancer patients who underwent neoadjuvant chemoradiotherapy and surgery between 2011-2016 was retrieved from the Dutch Upper Gastrointestinal Cancer Audit. Patients with <15 LNs and ≥15 LNs were compared after propensity score matching based on patient and tumor characteristics. The primary endpoint was 3-year survival. To evaluate the effect of LN yield on the accuracy of pathological staging, pathological N-stage was evaluated and 3-year survival was analyzed in a subgroup of patients node-negative disease. Results In 2260 of 3281 patients (67%) ≥15 LNs were retrieved. In total, 992 patients with ≥15 LNs were matched to 992 patients with <15 LNs. The 3-year survival did not differ between the two groups (57% versus 54%, p=0.28). pN+ was scored in 41% of patients with ≥15 LNs versus 35% of patients with <15 LNs. For node-negative patients, the 3-year survival was significantly better for patients with ≥15 LNs (69% versus 61%, p=0.01). Conclusions In this propensity score matched cohort, 3-year survival was comparable for patients with ≥15 LNs, although increasing nodal yield was associated with more accurate staging. In node-negative patients, 3-year survival was higher for patients with ≥15 LNs.

PS02.016: MINIMALLY INVASIVE ESOPHAGECTOMY IN ESOPHAGEAL CANCER: EXPERIENCE IN THE FIRST 100 CASES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 124-125
Author(s):  
Atila Eroglu ◽  
Coskun Daharli ◽  
Yener Aydin ◽  
Ali Ulas ◽  
Haci Alici
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Cell Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Thoracoscopic Esophagectomy ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Background In this study, the efficiency of minimally invasive esophagectomy in esophageal cancer was examined. Methods A total of 100 consecutive patients who were hospitalized due to esophageal cancer and planned minimally invasive esophagectomy were evaluated prospectively between September 2013 and December 2017 in our clinic. Laparoscopic and thoracoscopic esophagectomy was performed in all of the patients included in the study. Inoperable cases were not included in the study. Age and sex of the patients, symptoms, localization of tumor, histopathological type, surgical modality, operation time, length of hospital stay and morbidity and mortality rates were reviewed. Results Thirty-eight (38%) patients were male and 62 (62%) patients were female. The mean age was 55.5 ± 10.8 (32–75 years). The most symptoms were dysphagy (96%) and weight loss (39%). Eighty-one patients (81%) had squamous cell cancer, ten (10%) had adenocarcinoma and nine had another form of esophageal cancer. Neoadjuvant chemoradiotherapy was performed in 36 of the 100 patients. Laparoscopic and thoracoscopic esophagectomy and intrathoracic anastomosis were performed in 94 patients (94%). Laparoscopic and thoracoscopic esophagectomy and neck anastomosis were performed in six patients (6%). The mean duration of operation was 260.1 ± 33.4 minutes (185–335 minutes). The mean intraoperative blood loss was 114.2 ± 191.4 ml (10–800 ml). In 51 (51%) of the patients, complications occurred in perioperative, early postoperative and late postoperative periods. In postoperative complications, anastomotic leak rate was eight patients (8%) and pulmonary complication rate was 21 patients (21%). While mortality was seen in three patients that had diabetes mellitus and hypertension, the 30-day mortality was 2% and the hospital mortality was 3%. The mean hospital stay was 11.2 ± 8.3 days (range 8–44). In our study, the probability of one-year overall survival was 91% and the probability of two years overall survival was 66%. Conclusion Minimally invasive esophagectomy is a safe and preferred method with low mortality, acceptable morbidity, short operative time and short hospital stay and has become a routine approach in the treatment of esophageal cancers. Multicenter studies to be performed in the near future will further assist in defining the benefits of minimally invasive esophagectomy. Disclosure All authors have declared no conflicts of interest.

scholarly journals Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3177
Author(s):  
Rishi Jain ◽  
Talha Shaikh ◽  
Jia-Llon Yee ◽  
Cherry Au ◽  
Crystal S. Denlinger ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Nutritional Status ◽  
Neoadjuvant Chemoradiotherapy ◽  
Hematologic Toxicity ◽  
Clinical Markers ◽  
Jejunostomy Tube ◽  
Feeding Jejunostomy ◽  
Reduce Weight Loss ◽  
The Impact

Background: Patients with esophageal cancer (EC) have high rates of malnutrition due to tumor location and treatment-related toxicity. Various strategies are used to improve nutritional status in patients with EC including oral and enteral support. Methods: We conducted a retrospective analysis to determine the impact of malnutrition and prophylactic feeding jejunostomy tube (FJT) placement on toxicity and outcomes in patients with localized EC who were treated with neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy. Results: We identified 125 patients who were treated with nCRT between 2002 and 2014. Weight loss and hypoalbuminemia occurred frequently during nCRT and were associated with multiple adverse toxicity outcomes including hematologic toxicity, nonhematologic toxicity, grade ≥3 toxicity, and hospitalizations. After adjusting for relevant covariates including the specific nCRT chemotherapy regimen received and the onset of toxicity, there were no significant associations between hypoalbuminemia, weight loss, or FJT placement and relapse-free survival (RFS) or overall survival (OS). FJT placement was associated with less weight loss during nCRT (p = 0.003) but was not associated with reduced toxicity or improved survival. Conclusions: Weight and albumin loss during nCRT for EC are important factors relating to treatment toxicity but not RFS or OS. While pretreatment FJT placement may reduce weight loss, it may not impact treatment tolerance or survival.

VS01.02: MEDIASTINAL LYMPH NODE DISSECTION DURING MINIMAL INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 44-44
Author(s):  
Hirokazu Noshiro ◽  
Yukie Yoda
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Minimally Invasive ◽  
Prone Position ◽  
Lymph Node Dissection ◽  
Conflicts Of Interest ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
Invasive Esophagectomy

Abstract Description As esophageal cancer reveals aggressive characteristics of lymph node metastasis, esophagectomy with extensive lymph node dissection is required as the optimal management in most cases. In spite of improvements in the survival rate, however, the procedure is still associated with significant postoperative morbidity and mortality. As minimally invasive surgery reduces both pain and the systemic inflammatory response, minimally invasive esophagectomy has been developed in an obvious attempt to reduce the incidence of postoperative complications. In addition, the magnified and clear views by thoracoscopy accelerate recognition for the fine and minute surgical anatomy of the mediastinum. Thoracoscopic mobilization of the esophagus and mediastinal lymph node dissection as part of a three-stage procedure was reported in the early 1990s. Recently, thoracoscopic esophageal mobilization and mediastinal dissection in the prone position has been developed. Enhanced visualization and improved ergonomics for surgeons in the prone position provide higher-quality mobilization and lymphadenectomy and contribute to enhancement of the learning curve. Especially, it is favorable during the procedures of upper mediastinal lymph node dissection which are the most complicated ones. During this lymph node dissection, the concept of lymphatic flow is very important. Now, it takes 3 hours and 15 minutes for the thoracic procedure, but the blood loss is less than 100 ml in our recent series. In the presentation, the surgical procedures of thoracoscopic or robotically-assisted esophagectomy in the prone position for esophageal cancer will be demonstrated and our surgical results of over 300 cases will be shown. Disclosure All authors have declared no conflicts of interest.

FA04.03: MIE VERSUS RAMIE: PROMISING RESULTS OF A SINGLE-CENTER AND SINGLE-SURGEON ANALYSIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 8-8
Author(s):  
Peter Grimminger ◽  
Evangelos Tagkalos ◽  
Edin Hadzijusufovic ◽  
Benjamin Babic ◽  
Hauke Lang
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Demographic Data ◽  
Circular Stapler ◽  
Reconstruction Technique ◽  
Invasive Esophagectomy ◽  
Icu Stay

Abstract Background Robot assisted surgery for esophageal cancer is rapidly increasing, especially high-volume centers with access to a robot. The fully robotic minimally invasive esophagectomy using 4 robotic arms in the abdomen and thorax (RAMIE4) is performed as standard procedure in our department. In this analysis we compare the results of our first 50 RAMIE4 procedures with our last 50 fully minimally-invasive esophagectomies (MIE), which was our standard prior the robotic era. Methods Between April 2016 and March 2018, the data from 100 consecutive patients with esophageal carcinoma undergoing modified Ivor-Lewis esophagectomy, performed by the same surgeon using the identical intrathoracic anastomotic reconstruction technique (circular stapler). 50 patients were treated with MIE and the other 50 with RAMIE4. Demographic data, extracted lymph nodes and R-status were compared. Complications occurred were compered according to the Dindo-Clavien classification. Results Demographic data did not show significant differences between the groups. The overall 30- and 90- mortality rates were 1% (1/100) and 3% (3/100) respectively (P = 0.305 and P = 0.499 respectively). In the RAMIE group the median lymph node harvest was significantly higher (27 vs. 23; P = 0.045), the median hospital stay was less in the RAMIE group, however not significantly (11.5d vs 13d; P = 0.112), the median ICU stay was significantly lower in the RAMIE group compared to MIE (1d vs 2.5d; P = 0.002). The complications according to the Dindo-Calvien classification were not significantly different between the two groups (P = 0.091). Conclusion In this study we were able to demonstrate the superiority of robotic assisted lymph node dissection for esophageal cancer surgery in a highly comparable setting. In addition the perioperative parameters, especially ICU stay seem to be in favor of RAMIE. The future potential of standardized RAMIE and RAMIE4 seems to be high. Disclosure All authors have declared no conflicts of interest.

Changes in cardiopulmonary reserves associated with neoadjuvant therapy in patients with esophageal cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15589-e15589
Author(s):  
W. L. Hofstetter ◽  
C. E. Hightower ◽  
G. S. Morris ◽  
X. G. Sun ◽  
B. J. Riedel ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Treatment Period ◽  
Exercise Testing ◽  
Functional Capacity ◽  
Neoadjuvant Chemoradiotherapy ◽  
Physiological Data ◽  
Peak Exercise ◽  
Increased Risk ◽  
Before And After

e15589 Background: Recent treatment trends for resectable esophageal cancer have moved toward the addition of neoadjuvant chemoradiotherapy. This additional therapy, however, places these patients at increased risk for loss of physiologic/functional capacity. If present, such declines can delay resection of the primary tumor until the patient has physiologically recovered from this insult. To determine whether physiological reserves decline, peak exercise performance was assessed before and after completing neoadjuvant therapy Methods: In this prospective study seventeen male patients (60.5 + 7.1 years) with esophageal cancers underwent a symptom limited, standard ramp bicycle ergometer cardiopulmonary exercise test (CPET) before and after completing neoadjuvant therapy. The exercise protocol sequentially entailed 3 minutes of quiet resting, 3 minutes of unloaded cycling, ramp protocol to peak exercise tolerance, and 3 minutes of recovery. Ramp rates (5–25 watts/.min) were individually chosen to achieve test durations of 8–12 minutes. Expired gases were measured for volume and gas fractions via breath-by-breath analysis (Medical Graphics CardiO2/CP system). STATISTICAL ANALYSIS: Physiological data were analyzed by paired t-tests (α=0.05). Data are presented as mean + standard deviation. Results: Pre treatment exercise testing occurred immediately before onset of treatment. Post treatment exercise testing typically occurred 45 + 17 days after neoadjuvant ended and 11 + 10 days before surgery. Peak exercise capacity (VO2peak) and anaerobic threshold declined 11.9 % and 10.5 % respectively (p < 0.01) over the neoadjuvant therapy treatment period. Both oxygen pulse (VO2/HR) and pulse pressure product (HR X SP) at VO2peak also significantly declined (p< 0.01) over the treatment period. Conclusions: These results suggest 1) both systemic and peripheral changes contribute to an overall physiological and functional decline in patients undergoing neoadjuvant therapy and 2) efforts aimed at preserving optimal physiological/functional capacity may be warranted during this period. No significant financial relationships to disclose.

Risk factors associated with outcomes following neoadjuvant chemoradiotherapy prior to esophagectomy in patients with adenocarcinoma of the esophagus.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 186-186
Author(s):  
Khalil Boussi ◽  
Tarita Thomas ◽  
Sam G. Pappas ◽  
Brendan Martin
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Treatment Outcomes ◽  
Neoadjuvant Therapy ◽  
Metastatic Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Factors Associated ◽  
Post Surgery ◽  
Positive Lymph Nodes

186 Background: The study was conducted to evaluate risk factors associated with treatment outcomes following concurrent chemoradiotherapy (CRT) and esophagectomy in patients diagnosed with resectable esophageal cancer. Methods: IRB approval was obtained to evaluate patients with esophageal cancer treated at our center from 2002 to 2017 with neoadjuvant CRT followed by esophagectomy. Patient characteristics pre and post-surgery including age, number of positive lymph nodes, length of time between neoadjuvant therapy and surgery were evaluated. Univariable and multivariable frailty survival analysis were used to evaluate the association between risk factors and treatment outcomes. Results: 74 patients met inclusion criteria of CRT and esophagectomy. Controlling for the number of days between the end of radiotherapy and surgery, the hazard of death for patients who developed metastatic cancer following completion of therapy was 2.08 (95 CI: 1.04 – 4.13) times higher compared to patients who did not develop metastasis (p = .04). Adjusting for metastatic cancer, for every five additional days between the end of radiotherapy and surgery, patients’ hazard of death increased 5% (HR = 1.05, 95 CI: 1.02 – 1.07, p < .001). Controlling for metastatic cancer and the number of positive nodes, for every one-year increase in age, patients’ hazard of recurrence decreased 5% (HR = 0.95, 95 CI: 0.91 – 0.99, p = .04). Adjusting for age and the number of positive nodes, the hazard of recurrence for patients who developed metastatic cancer was 28.57 (95 CI: 6.58-123.97) times higher compared to patients without metastasis (p < .0001). Conclusions: Longer duration between completion of CRT and surgery as well as developing metastatic disease are associated with a significantly higher hazard of death. Additionally, developing metastatic cancer, increase in age, and additional positive lymph nodes are all associated with a significantly higher hazard of recurrence. Optimal timing between neoadjuvant therapy and surgery needs to be evaluated further, as increasing hazard of death following therapy suggests that there may be a role for adjuvant chemotherapy in these patients.

Prognostic value of nutritional status for esophageal cancer patients undergoing neoadjuvant therapy and resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 133-133 ◽  
Author(s):  
Sabrina D Saeed ◽  
Jacques Fontaine ◽  
Luis Pena ◽  
Sarah E. Hoffe ◽  
Jessica Frakes ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Prognostic Value ◽  
Feeding Tube ◽  
Tube Placement ◽  
Significant Weight Loss ◽  
Increased Risk ◽  
The Impact

133 Background: Malnutrition, linked to decreased patient tolerance to chemotherapy and increased rates of therapy-related toxicity, negatively affects cancer prognosis. Esophageal carcinomas (EC) frequently present with dysphagia and significant weight loss which may be exacerbated by neoadjuvant chemoradiation, placing EC patients at an increased risk of malnutrition. We therefore aim to assess the prognostic value of pre-operative malnutrition for esophageal cancer patients undergoing neoadjuvant therapy (NAT). Methods: Query of our institution’s IRB approved database of 1113 EC patients (pts) identified 725 individuals who underwent NAT followed by resection from 1994-2018. Seventy-six pts were considered to be at higher nutritional risk during NAT, as indicated by significant weight loss and enteral feeding tube requirement (ETF+), while 644 did not receive pre-operative feeding tube placement (ETF–). Clinicopathologic characteristics, post-operative outcomes, and survival were compared between ETF+ and ETF– using various statistical methods. Results: Of the included pts, 83% were male with a median age of 64.5 (28-86) years. Between ETF+ (n = 76) and ETF– (n = 644), pt characteristics were balanced in terms of initial stage, age, histology and tumor location. A higher percentage of ETF+ pts had > 5% weight loss before NAT (32 vs. 6%; p < .01). ETF+ was associated with a significantly worse median survival (27 vs. 77 m; p < .01), but not with increased post-operative length of hospital stay (p = .69), complications (p = .20) or tumor recurrence (p = .89). Although completion of chemotherapy (p = .46) and radiation (p = .49) were comparable between ETF+ and ETF–, tumor response was worse in the ETF+ group (71 vs. 60% non-complete response; p = .02). Conclusions: Our results suggest that baseline malnutrition is a risk factor for poor survival and negatively impacts the efficacy of neoadjuvant therapy in EC patients. Poor response to NAT in malnourished patients may stem from impaired immune function. Future prospective studies should evaluate other parameters for nutritional assessment to further assess the impact of malnutrition on tumor regression and survival after NAT.

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