title: Body mass index kinetics and risk factors of malnutrition one year after radical oesophagectomy for cancer.
abstract: OBJECTIVE
  Malnutrition is common after oesophageal cancer surgery. This study aims to investigate body mass index (BMI) kinetics and the risk factors of malnutrition among 1-year disease-free survivors after radical transthoracic oesophagectomy for cancer.
  
  
  METHODS
  From a prospective single-institution database, 118 1-year disease-free survivors having undergone a R0 transthoracic oesophagectomy with gastric tubulization between 2000 and 2008 were identified retrospectively. BMI values were collected at the onset of the disease (pre-treatment BMI), at the time of surgery (preoperative BMI), at postoperative 6 months and 1 year after oesophagectomy (1-year BMI). Logistic regression was performed with adjustment for confounders to estimate odds ratios of the factors associated with a 1-year weight loss (WL) of at least 15% of the pre-treatment body weight (BW).
  
  
  RESULTS
  At the onset of the disease, 5 patients (4%) were underweighted (BMI < 8.5 kg/m&sup2;), 65 (55%) were normal (BMI = 18.5-24.9 kg/m&sup2;), 36 (31%) were overweighted (BMI > 25 kg/m&sup2;) and 12 (10%) were obese (BMI > 30 kg/m&sup2;). Mean pre-treatment, preoperative, postoperative 6-month and 1-year BMI values were 24.64 ± 4 kg/m&sup2;, 23.55 ± 3.8 kg/m&sup2;, 21.7 ± 3 kg/m&sup2; and 21.97 ± 4 kg/m&sup2;, respectively. One-year WL ≥ 15% of the pre-treatment BW was present in 29 patients (25%): 18 among the 48 patients (37%) with a pre-treatment BMI ≥ 25 and 11 among the 70 patients (15%) with pre-treatment BMI < 25 (P = 0.006). On logistic regression, initial overweighting was the sole independent prognosticator of 1-year postoperative WL of at least 15% of the pre-treatment BW (P = 0.039; OR: 2.96, [1.06-8.32]).
  
  
  CONCLUSIONS
  Postoperative malnutrition remains a severe problem after oesophageal cancer resection, even in long-term disease-free survivors. Overweight and obese patients are the segment population most exposed to this postoperative malnutrition, suggesting that such surgery could have substantial bariatric effect. A special vigilance programme on the nutritional status of this sub-group of patients should be the rule.
authors.affiliation: Aix-Marseille University and University Hospital of Marseille, APHM, Marseille,  France.
authors.forename: Moussa
authors.initials: M
authors.lastname: Ouattara
authors.forename: Xavier Benoit
authors.initials: XB
authors.lastname: D'Journo
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.forename: Delphine
authors.initials: D
authors.lastname: Trousse
authors.forename: Laetitia
authors.initials: L
authors.lastname: Dahan
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Jean Francois
authors.initials: JF
authors.lastname: Seitz
authors.forename: Pascal-Alexandre
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D050177:Overweight / Q000150:complications / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015431:Weight Loss / Q000502:physiology