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

Author:

Kauppila Joonas HORCID,Rosenlund Helen,Klevebro Fredrik,Johar Asif,Anandavadivelan PoornaORCID,Mälberg Kalle,Lagergren Pernilla

Abstract

ObjectivesTo 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).DesignProspective cohort study.SettingAll patients undergoing oesophagectomy for cancer in Sweden during 2013–2018.ParticipantsA 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 measuresThe 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.ResultsOf 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.ConclusionsMIE 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.

Funder

Stockholm County Council

Cancerfonden

NIHR Imperial Biomedical Research Centre

Radiumhemmets Forskningsfonder

Publisher

BMJ

Subject

General Medicine

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