Postoperative Weight Loss Does Not Resolve After Esophagectomy Despite Normal Serum Ghrelin Levels

Background. Esophagectomy after gastric reconstruction leads to significant weight loss. Ghrelin is known to stimulate appetite and cause weight increase. The objective of this study is to examine the relationship of serum ghrelin levels and weight loss in patients after esophagectomy for cancer. Methods. Twenty-two patients underwent esophagectomy including gastric reconstruction. Serum ghrelin levels and weight were measured preoperatively and then postoperatively for 12 months in all patients. A questionnaire assessed appetite, amount of food eaten, satisfaction, and frequency of eating. Results. Preoperatively, the mean serum ghrelin level was 67.9 +/- 42.6 (fmol/mL +/- SD), and at 1, 3, 6, and 12 months after surgery were 43.4 +/- 28.1, 51.5 +/- 32.2, 67.1 +/- 50.9, and 84.9 +/- 43.1, respectively. Compared with preoperative values, the mean body mass index decreased by 1.9 +/- 1.5, 2.3 +/- 1.8, 2.1 +/- 2.3, 2.4 +/- 2.7 at 1, 3, 6, and 12 months after surgery. While appetite score showed a decrease at 1 month (1.6 +/- 0.92), appetite increased by 12 months postoperatively (2.7 +/- 1.0) and showed a strong positive correlation (r = 0.743) with serum ghrelin levels. There were no significant differences in ghrelin levels when patients were stratified by disease stage, recurrence, or administration of adjuvant chemotherapy. Conclusions. Esophagectomy resulted in temporary reduction of ghrelin levels, but while levels returned to normal 3 months later, weight loss persisted at 12 months. Further study is needed to elucidate the mechanisms of persistent weight loss and design therapeutic interventions to recover the weight lost. (Ann Thorac Surg 2011;91:1032-8) (C) 2011 by The Society of Thoracic Surgeons