title: Impact of nutritional factors on survival in patients with inoperable oesophageal cancer undergoing self-expanding metal stent insertion.
abstract: BACKGROUND
  Undernutrition has been shown to be predictive of 30-day mortality in patients undergoing self-expanding metal stent (SEMS) insertion for inoperable oesophageal cancer. The aim of this study was to assess the relationship between nutritional factors and 30-day mortality in patients undergoing SEMS insertion for palliation of oesophageal cancer.
  
  
  METHODS
  A retrospective cohort study was conducted from April 2007 to June 2009. BMI, swallowing ability, calorific intake and nature of nutritional support were recorded. ICD-10 causes of death were obtained from the Department of Health and Social Services.
  
  
  RESULTS
  Fifty-six stents were inserted into 53 patients (mean age 70 years, male n=35). Median (interquartile range) BMI was 21.0 kg/m (18.7-24.0). Median pre-SEMS swallowing grade was 3. Median calorific intake as a percentage of estimated daily requirements was 94.0% (75.6-100.0%). Thirty (56.6%) patients tolerated an oral diet enhanced with supplement drinks whereas 23 (43.4%) patients required more invasive forms of enteral and parenteral support. The 30-day mortality rate was 11.3% (n=6) and cumulative median survival was 84 (interquartile range 38-156) days. BMI, calorific intake and swallowing capacity were not predictors of survival. Although there was a nonsignificant trend for reduced survival in those patients who did (n=23) receive invasive nutritional support compared with those who did not (n=30) (83.9 vs. 151.3 days, P=0.053), invasive nutritional support itself was not predictive of 30-day mortality (P=0.74).
  
  
  CONCLUSIONS
  The requirement for invasive nutritional support before SEMS insertion is associated with a poor prognosis and possibly represents more aggressive tumour pathology. Further prospective assessment of prognostic factors, including nutritional parameters, to facilitate reliable selection of appropriate palliative modalities in oesophageal cancer is required.
authors.affiliation: Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK. rgray05@qub.ac.uk
authors.forename: Ronan T
authors.initials: RT
authors.lastname: Gray
authors.forename: Mark E
authors.initials: ME
authors.lastname: O'donnell
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Scott
authors.forename: James A
authors.initials: JA
authors.lastname: McGuigan
authors.forename: Inder
authors.initials: I
authors.lastname: Mainie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D002149:Energy Intake; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D004945:Esophagoscopy / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008670:Metals; D008875:Middle Aged; D009660:Northern Ireland; D009752:Nutritional Status; D018529:Nutritional Support / Q000401:mortality; D010166:Palliative Care; D018579:Patient Selection; D011474:Prosthesis Design; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals