Pharmacologic gut hormone modulation and eating behavior after esophagogastric cancer surgery: a narrative review

Oesophageal cancer is the ninth most common cancer and the sixth most common cause of cancer deaths worldwide [1]. Over the past number of years, due to earlier diagnosis and better treatment, we are seeing improvements in the survival rates of oesophageal cancer, with more patients living longer post-esophagectomy surgery. Unintentional weight loss is a common unintended feature seen in patients post-esophagectomy done with curative intent. Many recent studies have demonstrated the links between the pathophysiology of the weight loss following esophagogastric cancer surgery and the biological mechanism of weight loss following bariatric surgery. The predominant cause of the weight loss in both circumstances appears to the postoperative alterations in gut hormone signalling. This paper explores these over-lapping gut hormones signalling mechanisms and discusses the use of this increased understanding of hormone signalling to develop potential pharmacologic targets for the management of unintentional weight loss post-esophagogastric cancer surgery.

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Local Anesthetics and Recurrence after Cancer Surgery-What’s New? A Narrative Review

Journal of Clinical Medicine ◽

10.3390/jcm10040719 ◽

2021 ◽

Vol 10 (4) ◽

pp. 719

Author(s):

Sarah D. Müller ◽

Jonathan S. H. Ziegler ◽

Tobias Piegeler

Keyword(s):

Tumor Cells ◽

Circulating Tumor Cells ◽

Local Anesthetics ◽

Experimental Studies ◽

Perioperative Period ◽

Cancer Surgery ◽

Narrative Review ◽

Future Research ◽

Inflammatory Stress ◽

Research Activities

The perioperative use of regional anesthesia and local anesthetics is part of almost every anesthesiologist’s daily clinical practice. Retrospective analyses and results from experimental studies pointed towards a potential beneficial effect of the local anesthetics regarding outcome—i.e., overall and/or recurrence-free survival—in patients undergoing cancer surgery. The perioperative period, where the anesthesiologist is responsible for the patients, might be crucial for the further course of the disease, as circulating tumor cells (shed from the primary tumor into the patient’s bloodstream) might form new micro-metastases independent of complete tumor removal. Due to their strong anti-inflammatory properties, local anesthetics might have a certain impact on these circulating tumor cells, either via direct or indirect measures, for example via blunting the inflammatory stress response as induced by the surgical stimulus. This narrative review highlights the foundation of these principles, features recent experimental and clinical data and provides an outlook regarding current and potential future research activities.

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Does Breast Cancer Surgery Impact Functional Status and Independence in Older Patients? A Narrative Review

Oncology and Therapy ◽

10.1007/s40487-021-00170-4 ◽

2021 ◽

Author(s):

Zoe Chia ◽

Ruth M. Parks ◽

Kwok-Leung Cheung

Keyword(s):

Breast Cancer ◽

Functional Status ◽

Older Patients ◽

Cancer Surgery ◽

Narrative Review ◽

Breast Cancer Surgery

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A Pilot Study of Gut-Brain Signaling After Octreotide Therapy for Unintentional Weight Loss After Esophagectomy

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa697 ◽

2020 ◽

Vol 106 (1) ◽

pp. e204-e216

Author(s):

Conor F Murphy ◽

Nicholas Stratford ◽

Neil G Docherty ◽

Brendan Moran ◽

Jessie A Elliott ◽

...

Keyword(s):

Weight Loss ◽

Pilot Study ◽

Food Intake ◽

Eating Behavior ◽

Hormone Secretion ◽

Symptom Burden ◽

Octreotide Lar ◽

Gut Hormone ◽

Ad Libitum ◽

Brain Reward

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.

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