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Sarcopenia remaining after intensive nutritional feeding support could be a criterion for the selection of patients for surgery for oesogastric junction adenocarcinoma

  • Pierre de Mathelin
    Affiliations
    Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 1 avenue Molière, 67200, Strasbourg, France
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  • Simone Manfredelli
    Correspondence
    Corresponding author. Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Moliere, 67000, Strasbourg, France.
    Affiliations
    Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 1 avenue Molière, 67200, Strasbourg, France
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  • Jean-Baptiste Delhorme
    Affiliations
    Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 1 avenue Molière, 67200, Strasbourg, France

    Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200, Strasbourg, France
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  • Aina Venkatasamy
    Affiliations
    Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200, Strasbourg, France

    IHU-Strasbourg (Institut Hospitalo-Universitaire), 67091, Strasbourg, France

    Department of Radiology Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstrasse 5a, 79106, Freiburg, Germany
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  • Serge Rohr
    Affiliations
    Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 1 avenue Molière, 67200, Strasbourg, France

    Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200, Strasbourg, France
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  • Cécile Brigand
    Affiliations
    Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 1 avenue Molière, 67200, Strasbourg, France

    Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200, Strasbourg, France
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  • Christian Gaiddon
    Affiliations
    Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200, Strasbourg, France
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  • Benoît Romain
    Affiliations
    Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 1 avenue Molière, 67200, Strasbourg, France

    Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200, Strasbourg, France
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Published:November 05, 2022DOI:https://doi.org/10.1016/j.ejso.2022.11.012

      Highlights

      • Sarcopenia is recognized as a negative prognostic factor in several cancers.
      • Prehabilitation with nutritional support with feeding jejunostomy is a protective factor for sarcopenia occurrence in patients with esogastric junction adenocarcinoma.
      • Sarcopenia occurrence was an independent risk factor for overall survival in patients who underwent surgery.
      • Overall survival was similar between sarcopenic patients after nutritional prehabilitation with a FJ and patients excluded from surgery in palliative situations.
      • The persistence of sarcopenia despite renutrition program could be a selection factor for surgery.

      Abstract

      Background

      Sarcopenia is recognized as a negative prognostic factor in several cancers. The aim of this study was to investigate the impact of nutritional support with feeding jejunostomy (FJ) on the occurrence of sarcopenia and how it may affect postoperative short-term outcomes and long-term survival outcomes in patients undergoing esophagectomy for oesogastric junction adenocarcinoma (OJA).

      Methods

      Patients with OJA were included. The presence of sarcopenia was determined using cutoff values of the total cross-sectional muscle tissue measured on CT scan. We analyzed risk factors for sarcopenia occurrence and the impact of preoperative sarcopenia on postoperative results, overall survival and disease-free survival.

      Results

      A total of 124 patients were eligible for analysis. Ninety-one patients underwent surgery after chemotherapy, and 72 of them received preoperative FJ. Among the 91 patients, 21 patients (23.0%) were sarcopenic after preoperative chemotherapy. Multivariate analysis showed that FJ is a protective factor against sarcopenia occurrence. Overall survival was significantly different between sarcopenic and nonsarcopenic patients (median survival = 33.7 vs. 58.6 months, respectively, p = 0.04), and sarcopenia occurrence was an independent risk factor for overall survival in patients who underwent surgery (HR = 3.02; CI 95% 1.55–5.9; p < 0.005). Subgroup analyses showed no differences in overall survival between patients who presented sarcopenia despite nutritional prehabilitation with a FJ and patients excluded from surgery in palliative situations (median survival = 21.9 vs. 17.2 months, respectively, p = 0.46).

      Conclusion

      The persistence of sarcopenia after preoperative chemotherapy despite renutrition with FJ could be a selection factor to propose curative surgery for OJA.

      Keywords

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