Postoperative complications and days of hospitalization increase by 3 times and 12 days, respectively

AMC Esophageal Cancer Center, optimal treatment through pre- & post-operative nutritional care, multidisciplinary treatment, and minimally invasive surgery

▲ (from the left) Professor Yong-Hee Kim and Professor Hee Kyoung Na

Although esophageal cancer is not one of the ten major cancers in terms of incidence, it is known to be difficult to treat as it has the fifth lowest 5-year survival rate of the ten.

When esophageal cancer is found in its early stage, patients can undergo surgery directly without radiation or chemotherapy. A recent research revealed that the incidence of postoperative complication is associated with the length of hospital stay depending on the preoperative nutritional status of the patients.

Professor Hee Kyoung Na of the Division of Gastroenterology and Professor Yong-Hee Kim of the Department of Thoracic and Cardiovascular Surgery at AMC led a research team to analyze preoperative nutritional status and postoperative prognosis of 274 patients who underwent surgery for esophageal cancer. The team reported that the incidence of complications including pneumonia was three times higher and the length of hospital stay was around 12 days longer in patients with poor nutritional status according to the findings.

This suggests the need for thorough management of preoperative nutritional status through dietary consultation with a specialist as patients may lose their appetite or experience weight loss with an upcoming esophageal cancer surgery in some cases.

The research team conducted an analysis on 274 patients who underwent surgery for squamous cell carcinoma without receiving radiation or chemotherapy for the period between January 2012 and December 2016. The patients were divided into a group of good nutritional status (N=239) and poor nutritional status (N=35) and analyzed for postoperative complication incidence and duration of hospital stay.

Nutritional status of the patients were measured using various nutritional assessment indexes and it was confirmed from the analysis that the NRS 2002 index recommended by the ESPEN (European Society for Clinical Nutrition and Metabolism) was significantly associated with postoperative prognosis. NRS 2002 is a nutritional screening tool used by a medical professional to examine BMI, weight change, eating habits and severity of the disease. Patients with a score less than three are considered to be in good nutritional status and those with a score greater than or equal to three are considered malnourished.

It was demonstrated from the statistical analysis on both groups for the incidence of postoperative complications including pneumonia, anastomotic leakage, and bleeding was approximately three times higher in the group of poor nutritional status compared to the group of good nutritional status.

When looking at the incidence of each complication, the incidence of pneumonia was 20% in the group of poor nutritional status which is extremely higher than 4.2% in the group of good nutritional status. The incidence of anastomotic leakage* was also higher in the group of poor nutritional status with 5.7% compared to 2.5% of the group of good nutritional status.

(* Anastomotic leakage: One of the postoperative complications occurring when anastomosis fails and results in leakage after restoring the esophagus using gastrointestinal tissue)

Again, the duration of postoperative hospitalization in the group of poor nutritional status was approximately 12 days longer than the average hospitalization of 17.3 days in the group of good nutritional status.

Professor Hee Kyoung Na of the Division of Gastroenterology emphasized, “It was confirmed that patients with poor nutritional status may develop complications or experience longer hospitalization after surgery. Since this is likely to influence the overall survival, it is important to manage their nutritional status by, for example, taking nutritional supplements that can help improve appetite through preoperative dietary consultation with a specialist.”

Director Yong-Hee Kim of AMC Esophageal Cancer Center said, “AMC Esophageal Cancer Center offers optimized treatment taking advantage of accumulated knowledge through various clinical experience in addition to effective pre- & post-operative management of patient nutrition. Also, scars, pain, or complications are minimized and the quality of life of patients is improved by performing robot assisted surgeries that involve chest or abdomen perforation of less than one centimeter in size.”

AMC Esophageal Cancer Center was the first in South Korea to adopt an integrated multidisciplinary approach to skillfully deal with esophageal cancer that is difficult to treat. The Center has been a pioneer in customized treatment for esophageal cancer patients by engaging various clinical departments including Gastroenterology, Thoracic and Cardiovascular Surgery, Stomach Surgery, Radiation Oncology, Radiology and Oncology to come together for discussion on treatment strategy.

In addition, the Center is also helping patients recover and maintain their nutritional conditions through pre- & post-operative nutritional status screening, a dedicated dietician offering informative advice to patients on recommended or contraindicated food products accordingly, and education on how to increase nutrition density of their meals.

The research findings were recently published in ‘Nutrition and Cancer,’ an international academic journal.