The influence of preoperative weight loss on the postoperative course after esophageal cancer resection.
OBJECTIVE
Preoperative weight loss might increase the risk of postoperative morbidity and mortality after esophagectomy for cancer. We hypothesized that patients with esophageal cancer with >10% weight loss during the 3 months before their diagnosis would be at an increased risk of postoperative complications, have a longer length of stay, and have worse overall survival.


METHODS
In the present hospital-based cohort study, all patients who had undergone surgery for esophageal cancer in 1990 to 2010 at the Erasmus University Medical Center Rotterdam were included. Weight loss was defined as "no, or limited" (≤10%) or "severe" (>10%). Logistic regression analysis was used to estimate the relative risk of complications, expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Hazard ratios were calculated to assess the length of hospital stay and survival. The risk estimates were adjusted for potential confounding factors.


RESULTS
Of 922 included patients, 155 (17%) had experienced severe weight loss. These patients had no increased risk of early surgical, early nonsurgical, or late surgical complications (OR, 0.83 and 95% CI, 0.54-1.24; OR, 0.90 and 95% CI, 0.63-1.30; OR, 1.14 and 95% CI, 0.79-1.66, respectively) and had no increased length of stay (hazard ratio, 1.09; 95% CI, 0.89-1.35). Preoperative weight loss was followed by increased 5-year mortality (hazard ratio, 1.34; 95% CI, 1.02-1.74).


CONCLUSIONS
A >10% preoperative weight loss was followed by decreased 5-year survival after esophageal cancer surgery but no increased risk of postoperative complications.
Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: maartje.van.der.schaaf@ki.se.
Maartje K
MK
van der Schaaf
Department of Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Hugo W
HW
Tilanus
Department of Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jan J B
JJ
van Lanschot
Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Asif M
AM
Johar
Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Pernilla
P
Lagergren
Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Division of Cancer Studies, King's College London, London, United Kingdom.
Jesper
J
Lagergren
Department of Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Bas P L
BP
Wijnhoven
D000046:Academic Medical Centers; D000368:Aged; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
7; BMI; CI; HR; OR; body mass index; confidence interval; hazard ratio; odds ratio