Minimally invasive surgical techniques for oesophageal cancer and nutritional recovery: a prospective population-based cohort study

Joonas H Kauppila; Helen Rosenlund; Fredrik Klevebro; Asif Johar; Poorna Anandavadivelan; Kalle Mälberg; Pernilla Lagergren

doi:10.1136/bmjopen-2021-058763

Minimally invasive surgical techniques for oesophageal cancer and nutritional recovery: a prospective population-based cohort study

BMJ Open. 2022 Sep 1;12(9):e058763. doi: 10.1136/bmjopen-2021-058763.

Authors

Joonas H Kauppila^{1

2}, Helen Rosenlund^{3

4}, Fredrik Klevebro³, Asif Johar³, Poorna Anandavadivelan³, Kalle Mälberg³, Pernilla Lagergren^{3

5}

Affiliations

¹ Surgical Care Sciences, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden joonas.kauppila@ki.se.
² Department of Surgery, University of Oulu, Oulu University Hospital, Oulu, Finland.
³ Surgical Care Sciences, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Orthopaedics, Danderyds Sjukhus AB, Stockholm, Sweden.
⁵ Department of Surgery & Cancer, Imperial College London, London, UK.

Abstract

Objectives: To explore whether the minimally invasive oesophagectomy (MIE) or hybrid minimally invasive oesophagectomy (HMIE) are associated with better nutritional status and less weight loss 1 year after surgery, compared with open oesophagectomy (OE).

Design: Prospective cohort study.

Setting: All patients undergoing oesophagectomy for cancer in Sweden during 2013-2018.

Participants: A total of 424 patients alive at 1 year after surgery were eligible, and 281 completed the 1-year assessment. Of these, 239 had complete clinical data and were included in the analysis.

Primary and secondary outcome measures: The primary outcome was nutritional status at 1 year after surgery, assessed using the abbreviated Patient-Generated Subjective Global Assessment questionnaire. The secondary outcomes included postoperative weight loss at 6 months and 1 year after surgery.

Results: Of the included patients, 78 underwent MIE, 74 HMIE while 87 patients underwent OE. The MIE group had the highest prevalence of malnutrition (42% vs 22% after HMIE vs 25% after OE), reduced food intake (63% vs 45% after HMIE vs 39% after OE), symptoms reducing food intake (60% vs 45% after HMIE vs 60% after OE) and abnormal activities/function (45% vs 32% after HMIE vs 43% after OE). After adjustment for confounders, MIE was associated with a statistically significant increased risk of reduced food intake 1 year after surgery (OR 2.87, 95% CI 1.47 to 5.61), compared with OE. Other outcomes were not statistically significantly different between the groups. No statistically significant associations were observed between surgical techniques and weight loss up to 1 year after surgery.

Conclusions: MIE was statistically significantly associated with reduced food intake 1 year after surgery. However, no differences were observed in weight loss between the surgical techniques. Further studies on nutritional impact of surgical techniques in oesophageal cancer are needed.

Keywords: NUTRITION & DIETETICS; Oesophageal disease; SURGERY.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Squamous Cell* / surgery
Cohort Studies
Esophageal Neoplasms* / surgery
Esophagectomy / methods
Humans
Minimally Invasive Surgical Procedures / adverse effects
Postoperative Complications / etiology
Prospective Studies
Retrospective Studies
Treatment Outcome