Prognostic impact of weight loss in 1-year survivors after transthoracic esophagectomy for cancer

Malnutrition is common 1 year after esophageal cancer surgery. However, the prognostic impact of this malnutrition on long-term outcome has been poorly reported. This study aims at determining the potential effect on disease-free survival (DFS) of weight loss observed at 1 year in disease-free survivors after curative esophageal resection. From a prospective single-institution database, 304 patients having undergone a transthoracic esophagectomy with two-field lymphadenectomy and gastric reconstruction between 1996 to 2008 were identified. Patients who died during the postoperative course (n= 24), patients who died within the first postoperative year (n= 12), patients who presented with an early recurrence within the first postoperative year (n= 20), and those who were lost to follow-up (n= 22) were excluded from the study, as well as those for whom the follow-up was shorter than 1 year (n= 21). The remaining 205 patients constituted a homogeneous group of 1-year disease-free survivors after full postoperative work-up and formed the material of the present study. Body weight (BW) values were collected before any treatment at the onset of symptoms (initial BW) and 1 year after esophagectomy. A 1-year weight loss (1-YWL) exceeding 10% of the initial BW defined an important malnutrition. Impact of the 1-YWL= or <10% of the initial BW on DFS was investigated. Logistic regression was performed to identify factors affecting DFS. The mean initial BW was 69.1 +/- 12 kg, corresponding to a mean body mass index (BMI) of 23.8 +/- 3 kg/m2. Preoperatively, 32 (15%) patients were in the underweight category (BMI < 20 kg/m2), 110 (54%) were in normal (BMI = 2024 kg/m2), and 63 (31%) were in the overweight category (BMI = 25 kg/m2). Mean 1-year BW was 63.5 +/- 12 kg. 1-YWL was <10% of the initial BW in 92 patients (45%) and =10% in 113 patients (55%). Accordingly, 5-year DFS rates were 66% (median: 80 months) and 48% (median: 51 months), respectively (P= 0.005). On multivariate analysis, only three independent variables affected the DFS significantly: clinical N stage (cN) status (P= 0.007; odds ratio: 1.99, 1.23.3), incomplete resection (P= 0.008, OR: 3.6, 1.39.3), and 1-YWL = 10% (P= 0.004, OR: 2.1: 1.23.4). 1-YWL of or exceeding 10% of the initial BW in 1-year disease-free survivors has a negative prognostic impact on DFS after esophagectomy for cancer. This information offers another view on the objectives of the perioperative nutritional care of these patients. Special vigilance program on the nutritional status in post-esophagectomy patients should be the rule.