title: Grade of esophageal cancer and nutritional status impact on postsurgery outcomes.
abstract: BACKGROUND
  Undernutrition is a well known underlying cause in both disease onset and outcome.
  
  
  OBJECTIVE
  To associate disease severity with pre surgical nutritional status, the main postsurgical complications, and mortality in esophagus cancer patients.
  
  
  METHODS
  Retrospective data from 100 patients (38-81 years old, 85% males) who had undergone esophagectomy (G1/n = 25) or gastro/jejunostomy (G2/n = 75) between 1995 and 2004. Data included clinical, endoscopic, histological (TNM-UICC), dietary, anthropometric, blood chemistry, and postsurgical (>30 days) complications and mortality. Surgical groups were compared by Student's test and existing associations between variables by either c² or Fisher exact tests with P = 0.05.
  
  
  RESULTS
  The studied sample was predominantly male (85%), white (80%), smokers and alcoholics (95%), dysphagics (95%) mostly presenting body weight loss before cancer diagnosis (78%). TNM III and IV predominated over I and II, associated (P≤0.005) with higher body mass index and hypoalbuminemia (<3.5 mg/dL) frequency. Esophagic obstructions (n = 77) were associated (P = 0.002) with lower body mass index (kg/m²). Postsurgical complications were more common in G1 (69.2%) than G2, predominantly with infections in G2 (80%) and pleura-pulmonary in G1 (61%). Body mass index and lower lymphocyte counts were associated with early infections and postsurgical complications in G2. Plasma albumin levels were lower in this group than G1, and were associated with postsurgical complications and mortality whereas lower lymphocyte counts was associated with mortality in G1.
  
  
  CONCLUSIONS
  Disease severity (or late diagnosis) is associated with poor nutritional status and palliative surgery which lead to more complicated postsurgery outcome and mortality. Early diagnosis and nutritional intervention are the recommended actions.
authors.affiliation: State University of São Paulo, Botucatu, SP, Brazil.
authors.forename: Flávia Andréia
authors.initials: FA
authors.lastname: Marin
authors.forename: Vânia Cristina
authors.initials: VC
authors.lastname: Lamônica-Garcia
authors.forename: Maria Aparecida Coelho de Arruda
authors.initials: MA
authors.lastname: Henry
authors.forename: Roberto Carlos
authors.initials: RC
authors.lastname: Burini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D004032:Diet; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D009367:Neoplasm Staging; D009752:Nutritional Status; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D015431:Weight Loss