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Impact of Peri-Operative Nutrition and Weight Loss in Resected Gastroesophageal Junction Cancers
Joyce Wong2,1, Maki Yamamoto*2, William J. Fulp2, Phuong T. Nguyen2, Khaldoun Almhanna2
1Surgery, Penn State Hershey Medical Center, Hershey, PA; 2Moffitt Cancer Center, Tampa, FL
Introduction: The long-term prognostic impact of malnutrition in patients with gastroesophageal junction (GEJ) cancers is not well defined. This study evaluates perioperative nutrition and outcome in patients undergoing resection for GEJ cancers.
Methods: From 2000-2013, a prospectively maintained, single institution database of patients undergoing surgery for GEJ cancers was reviewed. Perioperative nutrition parameters were analyzed, with overall survival (OS) and disease free survival (DFS) as primary outcomes. Weight loss was calculated from date of surgery to first post-discharge clinic visit.
Results: 202 patients were referred for surgical evaluation of GEJ tumors; of these 192 (95%) underwent resection and comprise the study cohort. The median age was 65 years, and 168 (88%) were male. 125 (71%) were overweight or obese, with BMI>25. The majority had adenocarcinoma (N=189, 98%). Most (N=93, 52%) were moderately-differentiated; 71 (40%) were poorly differentiated.
188 (98%) patients had a feeding jejunostomy tube placed at the time of resection. The median pre-operative albumin level was 4.1 (range 2.9-4.8). 84 (45%) were discharged with tube feeds. Of patients with perioperative weight recorded, 143 (93%) experienced weight loss, with 61 (43%) losing 5-10% of their pre-operative weight, and 58 (41%) losing >10%. The median weight loss was 7.7 kg (range 0.4-23.2), after a median 24 days post-surgery (range 5-244 days). Eleven patients gained weight following surgery, median gain of 4.6 kg at 22 days.
Median follow-up for the cohort was 14 months (range 0.3-144 months). Univariate analysis demonstrated that pre-resection albumin level impacted overall survival; however, this was not significant on multivariate analysis. Multivariate analysis also did not demonstrate that %weight loss, pre-operative BMI, operative factors, or presence of tube feeds at time of discharge impacted either OS or DFS.
Conclusion: Although perioperative weight loss is concerning, this did not impact OS or DFS.
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