Ghrelin reduction after esophageal substitution and its correlation to postoperative body weight loss in esophageal cancer patients.
BACKGROUND
Body weight loss is observed commonly after esophagectomy with gastric tube reconstruction in thoracic esophageal cancer patients. The functional and anatomical alteration of the stomach by this surgery should affect ghrelin secretion, a novel gastric hormone that upregulates body weight through appetite control and metabolic reaction.


METHODS
Early-phase postoperative alteration of serum ghrelin was measured before and at day 3 and day 7 after surgery in 9 patients. With 26 other patients, who had previously undergone surgery from 3 months to 67 months (mean, 25 months) before the present study period, the late-phase postoperative alteration of serum ghrelin was investigated along with postoperative body weight loss and serum leptin.


RESULTS
Serum ghrelin concentration, which was equivalent to the control group before surgery (88.6 fmol/mL vs 97.5 fmol/mL) significantly decreased by half at 3 and 7 days after surgery. Thereafter, the serum ghrelin decline continued in the outpatients within 1 year after surgery (58.8 fmol/mL), while it was marginal in those from 1 to 3 years after surgery (77.2 fmol/mL). Serum ghrelin was significantly higher than the control after 3 years (185.1 fmol/mL). Thus, a significant positive correlation was observed between ghrelin and time after surgery (P < .0001). Postoperative body weight loss was significant, averaged as DeltaBMI - 2.7 in the outpatients (P < .0001). Until 3 years after surgery, a significant correlation between ghrelin and postoperative body weight loss was observed (P = .0152), with those having higher serum ghrelin showing less body weight loss. Serum leptin correlated well with body weight (P = .0144), but not with postoperative time, the degree of body weight loss, or serum ghrelin concentration.


CONCLUSIONS
Gastric tube replacement for esophagectomy resulted in temporary reduction of ghrelin production, which is associated with body weight loss after surgery. The decline of ghrelin may play some role in the serious body weight loss after esophagectomy, thus encouraging clinical application of exogenous recombinant ghrelin for these patients.
Doki
Yuichiro
Y
Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. ydoko@surg2.med.osaka-u.ac.jp
Takachi
Ko
K
Ishikawa
Osamu
O
Miyashiro
Isao
I
Sasaki
Yo
Y
Ohigashi
Hiroaki
H
Nakajima
Hiromu
H
Hosoda
Hiroshi
H
Kangawa
Kenji
K
Sasakuma
Fujiko
F
Motoori
Masaaki
M
Imaoka
Shingi
S
D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004944:Esophagoplasty; D005260:Female; D054439:Ghrelin; D006801:Humans; D020738:Leptin / Q000097:blood; D008297:Male; D008875:Middle Aged; D036361:Peptide Hormones / Q000097:blood*; D011788:Quality of Life; D015431:Weight Loss
D054439:Ghrelin; D020738:Leptin; D036361:Peptide Hormones