University of Oulu

Kauppila, J. H., Rosenlund, H., Klevebro, F., Johar, A., Anandavadivelan, P., Mälberg, K., & Lagergren, P. (2022). Minimally invasive surgical techniques for oesophageal cancer and nutritional recovery: A prospective population-based cohort study. BMJ Open, 12(9), e058763.

Minimally invasive surgical techniques for oesophageal cancer and nutritional recovery : a prospective population-based cohort study

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Author: Kauppila, Joonas H.1,2; Rosenlund, Helen1,3; Klevebro, Fredrik1;
Organizations: 1Surgical Care Sciences, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
2Department of Surgery, University of Oulu, Oulu University Hospital, Oulu, Finland
3Department of Orthopaedics, Danderyds Sjukhus AB, Stockholm, Sweden
4Department of Surgery & Cancer, Imperial College London, London, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: BMJ, 2022
Publish Date: 2023-02-15


Objectives: To explore whether the minimally invasive oesophagectomy (MIE) or hybrid minimally invasive oesophagectomy (HMIE) are associated with better nutritional status and less weight loss 1 year after surgery, compared with open oesophagectomy (OE).

Design: Prospective cohort study.

Setting: All patients undergoing oesophagectomy for cancer in Sweden during 2013–2018.

Participants: A total of 424 patients alive at 1 year after surgery were eligible, and 281 completed the 1-year assessment. Of these, 239 had complete clinical data and were included in the analysis.

Primary and secondary outcome measures: The primary outcome was nutritional status at 1 year after surgery, assessed using the abbreviated Patient-Generated Subjective Global Assessment questionnaire. The secondary outcomes included postoperative weight loss at 6 months and 1 year after surgery.

Results: Of the included patients, 78 underwent MIE, 74 HMIE while 87 patients underwent OE. The MIE group had the highest prevalence of malnutrition (42% vs 22% after HMIE vs 25% after OE), reduced food intake (63% vs 45% after HMIE vs 39% after OE), symptoms reducing food intake (60% vs 45% after HMIE vs 60% after OE) and abnormal activities/function (45% vs 32% after HMIE vs 43% after OE). After adjustment for confounders, MIE was associated with a statistically significant increased risk of reduced food intake 1 year after surgery (OR 2.87, 95% CI 1.47 to 5.61), compared with OE. Other outcomes were not statistically significantly different between the groups. No statistically significant associations were observed between surgical techniques and weight loss up to 1 year after surgery.

Conclusions: MIE was statistically significantly associated with reduced food intake 1 year after surgery. However, no differences were observed in weight loss between the surgical techniques. Further studies on nutritional impact of surgical techniques in oesophageal cancer are needed.

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Series: BMJ open
ISSN: 2044-6055
ISSN-E: 2044-6055
ISSN-L: 2044-6055
Volume: 12
Issue: 9
Article number: e058763
DOI: 10.1136/bmjopen-2021-058763
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3122 Cancers
3141 Health care science
Funding: We also would like to thank the Cancerfonden (grant number 180685), the Cancer Research Funds of Radiumhemmet (grant number 171103) and the Stockholm County Council (grant number LS 2018-1157) for financial support. Pernilla Lagergren is supported by the NIHR Imperial Biomedical Research Centre (BRC) for her position at Imperial College London, London, UK.
Copyright information: © Author(s) 2022. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: