Presence and persistence of nutrition-related symptoms during the first year following esophagectomy with gastric tube reconstruction in clinically disease-free patients

E B Haverkort, J M Binnekade, O R C Busch, M I van Berge Henegouwen, R J de Haan, D J Gouma, E B Haverkort, J M Binnekade, O R C Busch, M I van Berge Henegouwen, R J de Haan, D J Gouma

Abstract

Background: Esophagectomy with gastric tube reconstruction results in a variety of postoperative nutrition-related symptoms that may influence the patient's nutritional status.

Methods: We developed a 15-item questionnaire, focusing on the nutrition-related complaints the first year after an esophagectomy. The questionnaire was filled out the first week after discharge and 3, 6, and 12 months after surgery. The use of enteral nutrition, meal size and frequency, social aspects related to eating, defecation pattern, and body weight were recorded at the same time points. We analyzed the relationship between the baseline characteristics and the number of nutrition-related symptoms, as well as the relationship between those symptoms and body weight with linear mixed models.

Results: We found no significant within-patient change for the total number of nutrition-related symptoms (P = 0.67). None of the baseline factors were identified as predictors of the complaint scores. The most frequently experienced complaints were early satiety, postprandial dumping syndrome, inhibited passage due to high viscosity, reflux, and absence of hunger. One year after surgery, meal sizes were still smaller, the social aspects of eating were influenced negatively, and patients experienced an altered stool frequency. Directly after the surgical procedure 78% of the patients lost weight, and the entire postoperative year the mean body weight remained lower (P = 0.47). We observed no association between the complaint scores and body weight (P = 0.15).

Conclusions: After an esophagectomy, most patients struggle with nutrition-related symptoms, are confronted with nutrition-related adjustments and a reduced body weight.

Figures

Fig. 1
Fig. 1
Study flow chart

References

    1. O’Rourke I, Tait N, Bull C, et al. Oesophageal cancer: outcome of modern surgical management. Aust N Z J Surg. 1995;65:11–16. doi: 10.1111/j.1445-2197.1995.tb01739.x.
    1. Bartels H, Stein HJ, Siewert JR. Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg. 1998;85:840–844. doi: 10.1046/j.1365-2168.1998.00663.x.
    1. Parshad R, Singh RK, Kumar A, et al. Adenocarcinoma of distal esophagus and gastroesophageal junction: long-term results of surgical treatment in a North Indian Center. World J Surg. 1999;23:277–283. doi: 10.1007/PL00013179.
    1. Lerut T, Coosemans W, Decker G, et al. Extended surgery for cancer of the esophagus and gastroesophageal junction. J Surg Res. 2004;117:58–63. doi: 10.1016/j.jss.2003.12.012.
    1. Lagarde SM, de Boer JD, ten Kate FJ, et al. Postoperative complications after esophagectomy for adenocarcinoma of the esophagus are related to timing of death due to recurrence. Ann Surg. 2008;247:71–76. doi: 10.1097/SLA.0b013e31815b695e.
    1. Finley FJ, Lamy A, Clifton J, et al. Gastrointestinal function following esophagectomy for malignancy. Am J Surg. 1995;169:471–475. doi: 10.1016/S0002-9610(99)80197-4.
    1. Wainwright D, Donovan JL, Kavadas V, et al. Remapping the body: learning to eat again after surgery for esophageal cancer. Qual Health Res. 2007;17:759–771. doi: 10.1177/1049732307302021.
    1. Moraca RJ, Low DE. Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramucosal cancer. Arch Surg. 2006;141:545–549. doi: 10.1001/archsurg.141.6.545.
    1. Blazeby JM, Williams MH, Brookes ST, et al. Quality of life measurement in patients with oesophageal cancer. Gut. 1995;37:505–508. doi: 10.1136/gut.37.4.505.
    1. Gawad KA, Hosch SB, Bumann D, et al. How important is the route of reconstruction after esophagectomy: a prospective randomized study. Am J Gastroenterol. 1999;94:1490–1496. doi: 10.1111/j.1572-0241.1999.01131.x.
    1. McLarty AJ, Deschamps C, Trastek VF, et al. Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg. 1997;63:1568–1572. doi: 10.1016/S0003-4975(97)00125-2.
    1. De Leyn P, Coosemans W, Lerut T. Early and late functional results in patients with intrathoracic gastric replacement after oesophagectomy for carcinoma. Eur J Cardiothorac Surg. 1992;6:79–84. doi: 10.1016/1010-7940(92)90079-D.
    1. Ludwig DJ, Thirlby RC, Low DE. A prospective evaluation of dietary status and symptoms after near-total esophagectomy without gastric emptying procedure. Am J Surg. 2001;181:454–458. doi: 10.1016/S0002-9610(01)00600-6.
    1. Baba M, Aikou T, Natsugoe S, et al. Appraisal of ten-year survival following esophagectomy for carcinoma of the esophagus with emphasis on quality of life. World J Surg. 1997;21:282–285. doi: 10.1007/s002689900229.
    1. Conroy T, Marchal F, Blazeby JM. Quality of life in patients with oesophageal and gastric cancer: an overview. Oncology. 2006;70:391–402. doi: 10.1159/000099034.
    1. Ryan AM, Rowley SP, Healy LA, et al. Post-oesophagectomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit. Clin Nutr. 2006;25:386–393. doi: 10.1016/j.clnu.2005.12.003.
    1. Page RD, Oo AY, Russell GN, et al. Intravenous hydration versus naso-jejunal enteral feeding after esophagectomy: a randomised study. Eur J Cardiothorac Surg. 2002;22:666–672. doi: 10.1016/S1010-7940(02)00489-X.
    1. Baldwin C, Weekes CE (2008) Dietary advice for illness-related malnutrition in adults. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD002008. doi:10.1002/14651858.CD002008.pub3
    1. Wilson MMG, Vaswani S, Liu D, et al. Prevalence and causes of undernutrition in medical outpatients. Am J Med. 1998;104:56–63. doi: 10.1016/S0002-9343(97)00279-9.
    1. Stratton RJ, Green CJ, Elia M (2003) Disease related malnutrition: an evidence-based approach to treatment, 1st edn. CABI Publishing, Cambridge
    1. Guideline Perioperative Nutrition. Dutch Institute for Healthcare Improvement CBO, Utrecht (2007)
    1. De Boer AG, van Lanschot JJ, van Sandick JW, et al. Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus. J Clin Oncol. 2004;22:4202–4208. doi: 10.1200/JCO.2004.11.102.
    1. Hulscher JB, Tijssen JG, Obertop H, et al. Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg. 2001;72:306–313. doi: 10.1016/S0003-4975(00)02570-4.
    1. Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347:1662–1669. doi: 10.1056/NEJMoa022343.
    1. Cense HA, Visser MR, van Sandick JW, et al. Quality of life after colon interposition by necessity for esophageal cancer replacement. J Surg Oncol. 2004;88:32–38. doi: 10.1002/jso.20132.
    1. Hölscher AH, Voit H, Buttermann G, et al. Function of the intrathoracic stomach as esophageal replacement. World J Surg. 1988;12:835–844. doi: 10.1007/BF01655491.
    1. Viklund P, Lindblad M, Lagergren J. Influence of surgery-related factors on quality of life after esophageal or cardia cancer resection. World J Surg. 2005;29:841–848. doi: 10.1007/s00268-005-7887-9.
    1. van Knippenberg FC, Out JJ, Tilanus HW, et al. Quality of life in patients with resected oesophageal cancer. Soc Sci Med. 1992;35:139–145. doi: 10.1016/0277-9536(92)90161-I.
    1. Nakamura M, Kido Y, Hosoya Y, et al. Postoperative gastrointestinal dysfunction after 2-field versus 3-field lymph node dissection in patients with esophageal cancer. Surg Today. 2007;37:379–382. doi: 10.1007/s00595-006-3413-4.
    1. Stratton RJ, Stubbs RJ, Elia M. Short-term continuous enteral tube feeding schedules did not suppress appetite and food intake in healthy men in a placebo-controlled trial. J Nutr. 2003;133:2570–2576.
    1. Steyn RS, Grenier I, Darnton SJ, et al. Weight gain as an indicator of response to chemotherapy for oesophageal carcinoma. Clin Oncol (R Coll Radiol) 1995;7:382–384.
    1. Nishihira T, Watanabe T, Ohmori N, et al. Long-term evaluation of patients treated by radical operation for carcinoma of the esophagus. World J Surg. 1984;8:778–785. doi: 10.1007/BF01655780.

Source: PubMed

3
Se inscrever