Clinical effect of enteral nutrition support during neoadjuvant chemotherapy on the preservation of skeletal muscle mass in patients with esophageal cancer

Background & aims: Reductions in skeletal muscle mass during neoadjuvant therapy can have a negative effect on short- and long-term outcomes in patients with esophageal cancer. However, effective treatment for suppressing reductions in skeletal muscle mass during neoadjuvant therapy has not been established. Methods: Eighty-seven patients were included in this study who were enrolled in a previous randomized study comparing the effects of enteral nutrition (EN) and parenteral nutrition (PN) on chemotherapyrelated toxicities during neoadjuvant chemotherapy in esophageal cancer patients. Changes in skeletal muscle mass during neoadjuvant therapy were compared between the two groups. Results: Skeletal muscle mass index (SMI) decreased from 45.8 cm2/m2 before treatment to 43.7 cm2/m2 after neoadjuvant chemotherapy in 87 patients (p = 0.092). The total calorie intake during neoadjuvant therapy was equal between the two groups. SMI reduction was significantly smaller in the EN group than in the PN group (-1.4 cm2/m2 vs -3.0 cm2/m (Gebski et al., 2007) [2], p < 0.001). EN support was identified as the only independent factor adversely associated with severe SMI reduction (p < 0.001). Patients with low SMI after neoadjuvant chemotherapy were more susceptible to postoperative complications than patients with moderate SMI (47.6% vs 16.7%, p = 0.007), especially pulmonary complications (31.8% vs 10.8%, p = 0.003). Patients with low SMI after neoadjuvant chemotherapy tended to show worse prognosis than patients with moderate SMI (5-year overall survival rate: 43.8% vs 62.1%, p = 0.194). Conclusions: Compared with PN support, EN support during neoadjuvant chemotherapy suppressed reductions in skeletal muscle mass in patients with esophageal cancer. 0 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Automated summary

Enteral nutrition support during neoadjuvant chemotherapy can effectively suppress reductions in skeletal muscle mass in esophageal cancer patients, reducing the risk of postoperative complications.