Assessing the influence of weight and nutrition on recovery and quality of life after esophagectomy for cancer

Esophageal cancer is nowadays still the 8th highest cause of cancer death worldwide, despite the current available treatment modalities. Yearly, about 1200 patients in Belgium are diagnosed, but only one third will be referred for surgery. Depending on the stage, this already selected group of  patients undergoes primary surgery or receives surgery after neoadjuvant therapy.

The outcome of patients with esophageal cancer depends on adequate staging and radical surgery, including adequate lymph node dissection. Although oncological survival has improved by performing surgery according to high standards, the surgery itself still has a detrimental impact on physical function which only recovers slowly in the months after the operation. In this perspective, the focus of research and clinical management shifted towards improving quality of life (QoL), reducing morbidity and mortality and improving overall and disease specific survival after esophageal resection. The influence of pathology evaluation on survival, the implementation of minimal invasive surgery and finally the relationship between postoperative complications and quality of life were recently investigated by our group. 

How nutrition can improve functional quality of life and survival by influencing  post-operative catabolism is a still under-investigated research question. More research is pointing towards loss of lean body mass as a cause for frailty in cancer patients. Based on emerging results from the clinical field, the European Society on Clinical Nutrition and Metabolism defined sarcopenia more in detail as an underlying cause for morbidity as well as mortality.[6] To tackle this postoperative weight loss, currently a plethora of peri-operative nutritional strategies after esophagectomy are described in literature. Randomized controlled trials being rather scarce, the guidelines for nutritional management after esophagectomy are predominantly based on expert opinions.

Not only the route but also timing of nutritional support is still under review. Starting too early might cause an inflammatory reaction and coinciding muscle weakness, whereas introducing feeding support too late could lead to continuation of a caloric deficit and sarcopenia, with a negative effect on muscle mass and rehabilitation. In this research project we want to identify patients at risk for survival after esophagectomy due to preoperatively existing malnutrition. Once identified, these patients could then take advantage of nutritional support strategies after surgery. By means of a randomised controlled trial, the EFECTS-trial, generously funded by 'Kom Op Tegen Kanker' (Stand up To Cancer, the Flemish Cancer Society) and 'FWO' (Fund for Scientific Research - Flanders), we want to develop a scientifically underbuilt strategy for a selected patient group in order to potentially reduce  morbidity and mortality. In a broader context, adhering to patient tailored strategies can also be of financial interest in the perspective of rising health care expenses.