Nutritional optimization during neoadjuvant therapy prior to surgical resection of esophageal cancer-a narrative review

被引:52
作者
Huddy, J. R. [1 ]
Huddy, F. M. S. [2 ]
Markar, S. R. [1 ]
Tucker, O. [3 ,4 ]
机构
[1] Imperial Coll London, Dept Surg & Canc, London, England
[2] Royal Surrey Cty Hosp, Dept Oesophagogastr Surg, Guildford, Surrey, England
[3] Heart England NHS Fdn Trust, Dept Oesophagogastr Surg, Birmingham, W Midlands, England
[4] Univ Birmingham, Birmingham, W Midlands, England
来源
DISEASES OF THE ESOPHAGUS | 2018年 / 31卷 / 01期
关键词
esophageal cancers; esophageal cancer surgery; neoadjuvant; nutrition; LAPAROSCOPIC FEEDING JEJUNOSTOMY; PERCUTANEOUS ENDOSCOPIC GASTROSTOMY; RANDOMIZED CONTROLLED-TRIAL; PHASE-III TRIAL; ENTERAL NUTRITION; JUNCTIONAL CANCER; ESPEN GUIDELINES; TUBE PLACEMENT; GASTRIC-CANCER; SURGERY;
D O I
10.1093/dote/dox110
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
This narrative review aims to evaluate the evidence for the different nutritional approaches employed during neoadjuvant therapy in patients with locoregional esophageal cancer. Patients with esophageal cancer are often malnourished and difficult to optimize nutritionally. While evidence suggests that neoadjuvant therapy can offer a survival advantage, associated toxicity can exacerbate poor nutritional status. There is currently no accepted standard of care regarding optimal nutritional approach. A systematic literature search was undertaken. Studies describing the utilization of an additional nutritional intervention in patients with esophageal cancer receiving neoadjuvant therapy prior to esophagectomy were included. Primary outcome measure was 30-day postoperative mortality after esophagectomy. Secondary outcome measures were loss of weight during neoadjuvant therapy, completion rate of intended neoadjuvant therapy, complications from nutritional intervention, 30-day postoperative morbidity after esophagectomy and quality of life during neoadjuvant treatment. Given the heterogeneity of retrieved articles results was presented as a narrative review. Twenty-five studies were included of which 16 evaluated esophageal stenting, four feeding jejunostomy, three gastrostomy, one nasogastric feeding, and one comparative study of esophageal stenting to feeding jejunostomy. 30-day postoperative mortality was only reported in two of the 26 included studies limiting comparison between nutritional strategies. All studies of esophageal stents reported improvements in dysphagia with reported weight change ranging from -5.4 to +6 kg and one study reported 30-day postoperative mortality after esophagectomy (10%). In patients undergoing esophageal stenting for their neoadjuvant treatment overall migration rate was 29.9%. Studies of laparoscopically inserted jejunostomy were all retrospective reviews that demonstrated an increase in weight ranging from 0.4 to 11.8 kg and similarly no study reported 30-day postoperative mortality. Only one comparative study was included that compared esophageal stents to jejunostomy. This study reported no significant difference between the two groups in respect to complication rates (stents 22% vs. jejunostomy 4%, P = 0.11) or increase in weight (stents 4.4 kg vs. jejunostomy 4.2 kg, P = 0.59). Quality of life was also poorly reported. This review demonstrates the uncertainty on the optimal nutritional approach for patients with resectable esophageal cancer undergoing neoadjuvant treatment prior to esophagectomy. A prospective, multicenter, observational cohort study is needed to determine current practice and inform a prospective clinical trial.
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页数:11
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共 57 条
[1]   Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy [J].
Adler, Douglas G. ;
Fang, John ;
Wong, Robert ;
Wills, Jason ;
Hilden, Kristen .
GASTROINTESTINAL ENDOSCOPY, 2009, 70 (04) :614-619
[2]   Guidelines for the management of oesophageal and gastric cancer [J].
Allum, William H. ;
Blazeby, Jane M. ;
Griffin, S. Michael ;
Cunningham, David ;
Jankowski, Janusz A. ;
Wong, Rachel .
GUT, 2011, 60 (11) :1449-1472
[3]   Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? [J].
Andreyev, HJN ;
Norman, AR ;
Oates, J ;
Cunningham, D .
EUROPEAN JOURNAL OF CANCER, 1998, 34 (04) :503-509
[4]  
[Anonymous], ANN SURG
[5]   Nutritional Risk Factors in Planned Oncologic Surgery: Clinical and Biological Parameters Should Be Routinely What Used? [J].
Antoun, Sami ;
Rey, Annie ;
Beal, Jacqueline ;
Montange, Fabienne ;
Pressoir, Martine ;
Vasson, Marie-Paule ;
Dupoiron, Denis ;
Gourdiat-Borye, Anne ;
Guillaume, Alain ;
Maget, Brigitte ;
Nitenberg, Gerard ;
Raynard, Bruno ;
Bachmann, Patrick .
WORLD JOURNAL OF SURGERY, 2009, 33 (08) :1633-1640
[6]   ESPEN guidelines on enteral nutrition:: Non-surgical oncology [J].
Arends, J. ;
Bodoky, G. ;
Bozzetti, F. ;
Fearon, K. ;
Muscaritoli, M. ;
Selga, G. ;
van Bokhorst-de van der Schuereng, M. A. E. ;
von Meyenfeldt, M. ;
Zuercher, G. ;
Fietkau, R. ;
Aulbert, E. ;
Frick, B. ;
Holm, M. ;
Kneba, M. ;
Mestrom, H. J. ;
Zander, A. .
CLINICAL NUTRITION, 2006, 25 (02) :245-259
[7]   Pre-therapy Laparoscopic Feeding Jejunostomy is Safe and Effective in Patients Undergoing Minimally Invasive Esophagectomy for Cancer [J].
Ben-David, Kfir ;
Kim, Tad ;
Caban, Angel M. ;
Rossidis, Georgios ;
Rodriguez, Sara S. ;
Hochwald, Steven N. .
JOURNAL OF GASTROINTESTINAL SURGERY, 2013, 17 (08) :1352-1358
[8]   Nutritional Support with Endoluminal Stenting During Neoadjuvant Therapy for Esophageal Malignancy [J].
Bower, Matthew ;
Jones, Whitney ;
Vessels, Ben ;
Scoggins, Charles ;
Martin, Robert .
ANNALS OF SURGICAL ONCOLOGY, 2009, 16 (11) :3161-3168
[9]   Nutritional approach in malnourished surgical patients - A prospective Randomized study [J].
Braga, M ;
Gianotti, L ;
Nespoli, L ;
Radaelli, G ;
Di Carlo, V .
ARCHIVES OF SURGERY, 2002, 137 (02) :174-180
[10]   A Prospective Phase II Evaluation of Esophageal Stenting for Neoadjuvant Therapy for Esophageal Cancer: Optimal Performance and Surgical Safety [J].
Brown, Russell E. ;
Abbas, Abbas E. ;
Ellis, Susan ;
Williams, Shannon ;
Scoggins, Charles R. ;
McMasters, Kelly M. ;
Martin, Robert C. G., II .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2011, 212 (04) :582-588