Body mass index kinetics and risk factors of malnutrition one year after radical oesophagectomy for cancer

Abstract

Objective: Malnutrition is common after oesophageal cancer surgery. This study aims to investigate body mass index (BMI) kinetics and the risk factors of malnutrition among 1-year disease-free survivors after radical transthoracic oesophagectomy for cancer. Methods: From a prospective single-institution database, 118 1-year disease-free survivors having undergone a R0 transthoracic oesophagectomy with gastric tubulization between 2000 and 2008 were identified retrospectively. BMI values were collected at the onset of the disease (pre-treatment BMI), at the time of surgery (preoperative BMI), at postoperative 6 months and 1 year after oesophagectomy (1-year BMI). Logistic regression was performed with adjustment for confounders to estimate odds ratios of the factors associated with a 1-year weight loss (WL) of at least 15% of the pre-treatment body weight (BW). Results: At the onset of the disease, 5 patients (4%) were underweighted (BMI < 8.5 kg/m2), 65 (55%) were normal (BMI = 18.5-24.9 kg/m2), 36 (31%) were overweighted (BMI > 25 kg/m2) and 12 (10%) were obese (BMI > 30 kg/m2). Mean pre-treatment, preoperative, postoperative 6-month and 1-year BMI values were 24.64 ± 4 kg/m2, 23.55 ± 3.8 kg/m2, 21.7 ± 3 kg/m2 and 21.97 ± 4 kg/m2, respectively. One-year WL = 15% of the pre-treatment BW was present in 29 patients (25%): 18 among the 48 patients (37%) with a pre-treatment BMI = 25 and 11 among the 70 patients (15%) with pre-treatment BMI < 25 (P = 0.006). On logistic regression, initial overweighting was the sole independent prognosticator of 1-year postoperative WL of at least 15% of the pre-treatment BW (P = 0.039; OR: 2.96, [1.06-8.32]). Conclusions: Postoperative malnutrition remains a severe problem after oesophageal cancer resection, even in long-term diseasefree survivors. Overweight and obese patients are the segment population most exposed to this postoperative malnutrition, suggesting that such surgery could have substantial bariatric effect. A special vigilance programme on the nutritional status of this sub-group of patients should be the rule. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.