Impact of regular enteral feeding via jejunostomy during neoadjuvant chemotherapy on body composition in patients with oesophageal cancer

Abstract

BACKGROUND Malnourishment and sarcopenia are well documented phenomena in oesophageal cancer. Patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy have complex nutritional needs. AIM To examine the effect of regular nutritional support via feeding jejunostomy on overall body composition in patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy for oesophageal cancer. METHODS Retrospective data were collected for 15 patients before and after neo-adjuvant chemotherapy. All patients had feeding jejunostomies inserted at staging laparoscopy prior to neo-adjuvant chemotherapy and underwent regular jejunostomy feeding. Changes in body composition were determined by analysis of computed tomography imaging. RESULTS Patient age was 61.3 ± 12.8 years, and 73% of patients were male. The time between start of chemotherapy and surgery was 107 ± 21.6 d. There was no change in weight (74.5 ± 14.1 kg to 74.8 ± 13.1 kg) and body mass index (26.0 ± 3.8 kg/m2 to 26.1 ± 3.4 kg/m2). Body composition analysis revealed a statistically significant decrease in lumbar skeletal muscle index despite regular feeding (45.8 ± 8.0 cm2/m2 to 43.5 ± 7.3 cm2/m2; P = 0.045). The proportion of sarcopenic patients increased (33.3% to 60%). Six patients (40%) experienced dose-limiting toxicity during chemotherapy. CONCLUSION Regular jejunostomy feeding during neo-adjuvant chemotherapy can maintain weight and adipose tissue. Feeding alone is not sufficient to maintain muscle mass. Further insight into the underlying processes causing reduced muscle mass in cancer patients may help to provide targeted interventions.