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Miki Y, Nishi S, Tamura T, Imai T, Nambara M, Fukuoka T, Yoshii M, Toyokawa T, Lee S, Fujii H, Yoshida H, Ikebuchi M, Maeda K. Protocol of a pilot randomized clinical trial to evaluate nutritional support and rehabilitation on prevention of skeletal muscle mass loss during neoadjuvant chemotherapy in patients with esophageal cancer. PLoS One 2024; 19:e0302003. [PMID: 38635741 PMCID: PMC11025928 DOI: 10.1371/journal.pone.0302003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Subtotal esophagectomy with lymph node dissection followed by neoadjuvant chemotherapy (NAC) is the standard treatment for stage II-III esophageal cancer. Esophagectomy is still associated with high morbidity rates, and reducing these rates remains challenging. Among several complications, postoperative pneumonia (PP) is sometimes fatal, which has been reportedly caused by sarcopenia. Thus, nutritional support and rehabilitation may be promising for preventing skeletal muscle mass loss and reduce the incidence of PP. METHODS This single-center, randomized, open-label, pilot trial will randomize a total of 40 patients with esophageal cancer in a 1:1 ratio either to ISOCAL Clear + rehabilitation arm or only rehabilitation arm. Although all patients will be educated about rehabilitation by a specialized physician and will be asked to undergo the prespecified rehabilitation program, patients treated with ISOCAL Clear + rehabilitation arm will be supplemented by 400 mL of ISOCAL Clear (Nestlé Japan Ltd, Tokyo, Japan) per day during two courses of NAC with docetaxel, cisplatin, and fluorouracil. Body composition will be assessed using Inbody (Inbody Co., Ltd., Tokyo, Japan) just before starting NAC and surgery. The primary endpoint is the change of skeletal muscle index (SMI) during NAC. Secondary endpoints include (i) body weight, total skeletal muscle mass, appendicular skeletal muscle mass, and lean body mass index changes; (ii) the percentage of ISOCAL Clear continuation; (iii) appetite evaluation; (iv) the percentage of targeted calorie achievement; (v) adverse events of NAC; (vi) postoperative complication rates; and (vii) postoperative hospital stay. DISCUSSION This prospective trial assesses the efficacy of nutritional support in addition to rehabilitation during NAC for patients with esophageal cancer. The results will be utilized in assessing whether the effects of nutritional support by ISOCAL Clear are promising or not and in planning future larger clinical trials.
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Affiliation(s)
- Yuichiro Miki
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Tatsuro Tamura
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takumi Imai
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Mikio Nambara
- Department of Surgery, Higashisumiyoshi Morimoto Hospital, Osaka, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Mami Yoshii
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Toyokawa
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hisako Fujii
- Department of Health and Medical Innovation, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Mitsuhiko Ikebuchi
- Department of Orthopaedics Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Nishikawa K, Kimura Y, Kishi K, Inoue K, Matsuyama J, Akamaru Y, Tamura S, Kawada J, Kawase T, Kawabata R, Fujiwara Y, Kanno H, Yamada T, Shimokawa T, Imamura H. Effects of postoperative oral elemental nutritional supplement on skeletal muscle loss after gastrectomy for gastric cancer. Int J Clin Oncol 2024; 29:266-275. [PMID: 38227091 DOI: 10.1007/s10147-023-02462-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND We previously showed that daily nutritional intervention with an oral elemental diet (ED) at 300 kcal/day for 6-8 weeks postoperatively decreased the percentage of body weight loss (%BWL), and that the effect was maintained for 1 year. This post hoc analysis aimed to determine whether this intervention decreased skeletal muscle mass loss 1-year post-gastrectomy. METHODS Data from consecutive, untreated patients with histopathologically confirmed stage I-III gastric adenocarcinoma who planned to undergo total gastrectomy (TG) or distal gastrectomy (DG) and were enrolled in a previously published randomized trial were used. The primary endpoint was the percentage of skeletal muscle mass index (%SMI) loss from baseline at 1 year postoperatively, based on abdominal computed tomography images obtained preoperatively and at 1 year postoperatively. RESULTS The overall median %SMI loss was lower in the ED versus control group, but the difference was not significant. The difference in %SMI loss in the ED and control groups was greater in patients with TG (10.1 vs. 13.0; P = 0.12) than in those with DG (5.5 vs. 6.8; P = 0.69). A correlation was observed between %BWL and %SMI loss in both groups (ED group, coefficient 0.591; control group, coefficient 0.644; P < 0.001 for both). Type of gastrectomy (coefficient 7.38; P = 0.001) and disease stage (coefficient - 6.43; P = 0.04) were independent predictors of postoperative skeletal muscle mass loss. CONCLUSION ED administration for 6-8 weeks following gastrectomy had no inhibitory effect on skeletal muscle loss at 1 year postoperatively. CLINICAL TRIAL REGISTRATION UMIN000023455.
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Affiliation(s)
- Kazuhiro Nishikawa
- Cancer Treatment Center, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka, 543-0035, Japan.
| | - Yutaka Kimura
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda-Cho, Ikoma, Nara, 630-0293, Japan
| | - Kentaro Kishi
- Department of Surgery, Hyogo Prefectural Nishinomiya Hospital, 13-9 Rokutanji-Cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Kentaro Inoue
- Department of Surgery, Kansai Medical University, 2 Chome-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan
| | - Jin Matsuyama
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, 3 Chome-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Yusuke Akamaru
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-Ku, Sakai City, Osaka, 591-8025, Japan
| | - Shigeyuki Tamura
- Department of Surgery, Yao Municipal Hospital, 1 Chome-3-1, Ryugecho, Yao City, , Osaka, 581-0069, Japan
| | - Junji Kawada
- Department of Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, 593-8304, Japan
| | - Tomono Kawase
- Department of Surgery, Toyonaka Municipal Hospital, 4 Chome-14-1 Shibaharacho, Toyonaka City, Osaka, 560-8565, Japan
| | - Ryohei Kawabata
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-Ku, Sakai City, , Osaka, 593-8304, Japan
| | - Yoshiyuki Fujiwara
- Faculty of Medicine, Division of Surgical Oncology, Department of Surgery, Tottori University, 86 Nishi-Cho, Yonago City, Tottori, 683-8503, Japan
| | - Hitoshi Kanno
- Department of Health Policy and Management, Nippon Medical School, 1 Chome-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan
| | - Takeshi Yamada
- Department of Digestive Surgery, Nippon Medical School, 1 Chome-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, 4 Chome-14-1 Shibaharacho, Toyonaka City, Osaka, 560-8565, Japan
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Takeoka T, Yamamoto K, Kurokawa Y, Miyazaki Y, Kawabata R, Omori T, Imamura H, Fujita J, Eguchi H, Doki Y. Comparison of the effects of open and laparoscopic approach on body composition in gastrectomy for gastric cancer: A propensity score-matched study. Ann Gastroenterol Surg 2024; 8:40-50. [PMID: 38250677 PMCID: PMC10797822 DOI: 10.1002/ags3.12723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 01/23/2024] Open
Abstract
Aim To compare the effects of open (OG) and laparoscopic gastrectomy (LG) on body composition and muscle strength. Methods This study performed a propensity score matching analysis using cases from a large-scale, multicenter, phase III randomized controlled trial concerning oral nutritional supplements after gastrectomy and analyzed both the whole and matched cohorts. Measurements of body composition and hand grip strength (HGS) were performed at baseline (preoperatively) and at 1, 2, 3, 6, and 12 months after gastrectomy. Results Of 835 patients, 275 and 560 underwent OG and LG, respectively. Skeletal muscle mass (SMM) and HGS loss were significantly lesser in the LG group than in the OG group. The propensity score-matched analysis, including 120 pairs of patients, confirmed that the % SMM loss values at 1, 2, 3, 6, and 12 POM were -4.5%, -4.0%, -4.7%, -4.6%, and -5.8% in the OG group and -3.0%, -1.9%, -2.4%, -2.2%, and -2.7% in the LG group, respectively. The % SMM loss was significantly lesser in the LG group than in the OG group (repeated measures ANOVA p < 0.001). The HGS loss was non-significantly smaller in the LG group than in the OG group. Conclusion Skeletal muscle mass loss was significantly lesser in the LG group than in the OG group in both cohorts, indicating that LG may be more effective than OG for maintaining muscle mass.
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Affiliation(s)
- Tomohira Takeoka
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
- Sakai City Medical CenterSakaiJapan
| | | | | | | | - Ryohei Kawabata
- Sakai City Medical CenterSakaiJapan
- Osaka Rosai HospitalOsakaJapan
| | - Takeshi Omori
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
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Endo S, Yamatsuji T, Fujiwara Y, Higashida M, Kubota H, Tanaka H, Ito Y, Okada T, Yoshiatsu K, Ueno T. The comparison of prognoses between total and distal gastrectomy for gastric cancer in elderly patients ≥ 80 years old. Surg Today 2022; 53:569-577. [PMID: 36418575 DOI: 10.1007/s00595-022-02599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE In Japan, the number of distal gastrectomy for patients ≥ 80 years old is increasing, whereas that of total gastrectomy is decreasing. Surgeons seem to avoid total gastrectomy for elderly patients. Total gastrectomy is reported to have a poorer prognosis than distal gastrectomy, and postoperative pneumonia may be involved in the cause. METHODS The medical records of 39 and 108 patients ≥ 80 years old who underwent total and distal gastrectomy, respectively, at 2 affiliated institutions between 2010 and 2019 were retrospectively reviewed. Prognoses were compared between the two groups, focusing on death from pneumonia. RESULTS The median overall survival time after total and distal gastrectomy was 21.3 and 74.1 months, respectively, with a significantly poorer prognosis after total gastrectomy than after distal gastrectomy (p < 0.01, hazard ratio [HR] 2.20, 95% confidence interval [CI] 1.37-3.53). The gastric cancer-specific survival time was significantly worse after total gastrectomy than after distal gastrectomy (p < 0.01, HR 2.73, 95% CI 1.29-5.79). The pneumonia-specific survival time was also significantly worse after total gastrectomy than after distal gastrectomy (p = 0.01, HR 3.44, 95% CI 1.25-9.48). CONCLUSIONS Patients who underwent total gastrectomy had a poorer prognosis than those who underwent distal gastrectomy, because many patients died of pneumonia early after total gastrectomy.
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