A nutritional management algorithm in older patients with locally advanced esophageal cancer

A Novel Frailty Index Can Predict the Short-Term Outcomes of Esophagectomy in Older Patients with Esophageal Cancer

Background: Frailty, rather than age, is associated with postoperative morbidity and mortality. We sought to determine whether preoperative frailty as defined by a novel scoring system could predict the outcomes among older patients undergoing esophagectomy. Methods: We identified patients 65 years or older who underwent esophagectomy between 2011 and 2021 at our institution. Frailty was assessed using the MSK-FI, which consists of 1 component related to functional status and 10 medical comorbidities. We used a multivariable logistic regression model to test for the associations between frailty and short-term outcomes, with continuous frailty score as the predictor and additionally adjusted for age and Eastern Cooperative Oncology Group performance status. Results: In total, 447 patients were included in the analysis (median age of 71 years [interquartile range, 68-75]). Most of the patients underwent neoadjuvant treatment (81%), an Ivor Lewis esophagectomy (86%), and minimally invasive surgery (55%). A total of 22 patients (4.9%) died within 90 days of surgery, 144 (32%) had a major complication, 81 (19%) were readmitted, and 31 (7.2%) were discharged to a facility. Of the patients who died within 90 days, 19 had a major complication, yielding a failure-to-rescue rate of 13%. The risk of 30-day major complications (OR, 1.24 [95% CI, 1.09-1.41]; p = 0.001), readmissions (OR, 1.31 [95% CI, 1.13-1.52]; p < 0.001), and discharge to a facility (OR, 1.86 [95% CI, 1.49-2.37]; p < 0.001) increased with increasing frailty. Frailty and 90-day mortality were not associated. Conclusions: Frailty assessment during surgery decision-making can identify patients with a high risk of morbidity.

Nutritional Support in Older Patients with Esophageal Cancer Undergoing Chemoradiotherapy

Esophageal cancer (EC) is the eighth most prevalent malignancy and the sixth leading cause of cancer-related death worldwide. The proportion of older adults with EC has increased dramatically in recent decades due to increased life expectancy. Older patients with EC are at a highest risk of malnutrition and this predicts early death. In older patients with EC, dysphagia is a common symptom; additionally, comorbidities, polypharmacy, and physiological changes of aging such as decreased muscle mass and geriatric issues including altered cognition, mobility, and mood contribute to malnutrition. Chemoradiotherapy (CRT) is the primary treatment for unresectable locally advanced EC patients, as it successfully reduces local recurrence and distant metastases while also extending survival. In older patients with EC, nutrition is an interventional condition, unlike many other geriatric risk factors. Optimizing nutritional support may reduce treatment toxicity and facilitate the completion of definitive or neoadjuvant CRT. The relevance of nutritional status and food intake is becoming more widely acknowledged, and it now encompasses the entire spectrum of EC treatment in older patients, from diagnosis to perioperative care to long-term care. This review aims to discuss the current research on nutritional support in older patients with esophageal cancer undergoing CRT.