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Nutritional outcomes and impact of malnutrition in a randomised comparison between standard and prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer

Ericson, Jessica ; Klevebro, Fredrik ; Sunde, Berit ; Szabo, Eva ; Halldestam, Ingvar ; Smedh, Ulrika ; Wallner, Bengt ; Johansson, Jan LU orcid ; Johnsen, Gjermund and Aahlin, Eirik Kjus , et al. (2025) In European Journal of Surgical Oncology 51(9).
Abstract

Background: Prolonged time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) may enable malnourished oesophageal cancer patients' nutritional status to recover better, possibly improving outcomes with fewer complications and better overall survival (OS) after oesophagectomy. Methods: This is a substudy within a multicentre randomised controlled trial comparing outcomes in patients with oesophageal cancer after standard TTS of 4–6 weeks to prolonged TTS of 10–12 weeks after nCRT. Patients were categorised as malnourished or non-malnourished at baseline and compared regarding weight, dysphagia, postoperative complications, and OS. Results: The mean weight from baseline to time of surgery decreased significantly in patients... (More)

Background: Prolonged time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) may enable malnourished oesophageal cancer patients' nutritional status to recover better, possibly improving outcomes with fewer complications and better overall survival (OS) after oesophagectomy. Methods: This is a substudy within a multicentre randomised controlled trial comparing outcomes in patients with oesophageal cancer after standard TTS of 4–6 weeks to prolonged TTS of 10–12 weeks after nCRT. Patients were categorised as malnourished or non-malnourished at baseline and compared regarding weight, dysphagia, postoperative complications, and OS. Results: The mean weight from baseline to time of surgery decreased significantly in patients allocated to standard TTS (p < 0.001) while patients with prolonged TTS recovered during the extended time to similar weight as at baseline (p = 0.131). The mean dysphagia score at the time of surgery improved significantly in both groups (p < 0.001). There were no significant differences between patients allocated to standard versus prolonged TTS regarding postoperative complications, regardless of malnourishment status at baseline. No significant differences in OS after prolonged TTS compared to standard TTS, was observed in neither malnourished patients (hazard ratio, HR 1.72 (95 %, CI: 0.82–3.59, p = 0.147) nor non-malnourished patients (HR 1.26 (95 % CI:0.82–1.94, p = 0.291). Conclusions: Prolonged TTS was associated with better weight recovery at the time of surgery compared to standard TTS. Patients malnourished at baseline did not benefit in terms of less postoperative complications after prolonged TTS.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Malnutrition, Neoadjuvant treatment, Oesophageal cancer, Postoperative outcomes, Time to surgery, Weight loss
in
European Journal of Surgical Oncology
volume
51
issue
9
article number
110228
publisher
Elsevier
external identifiers
  • scopus:105008434269
  • pmid:40550184
ISSN
0748-7983
DOI
10.1016/j.ejso.2025.110228
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Authors
id
2df6a9fb-e20b-4ad4-a26c-168c54546302
date added to LUP
2025-11-27 16:13:27
date last changed
2025-12-11 17:50:44
@article{2df6a9fb-e20b-4ad4-a26c-168c54546302,
  abstract     = {{<p>Background: Prolonged time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) may enable malnourished oesophageal cancer patients' nutritional status to recover better, possibly improving outcomes with fewer complications and better overall survival (OS) after oesophagectomy. Methods: This is a substudy within a multicentre randomised controlled trial comparing outcomes in patients with oesophageal cancer after standard TTS of 4–6 weeks to prolonged TTS of 10–12 weeks after nCRT. Patients were categorised as malnourished or non-malnourished at baseline and compared regarding weight, dysphagia, postoperative complications, and OS. Results: The mean weight from baseline to time of surgery decreased significantly in patients allocated to standard TTS (p &lt; 0.001) while patients with prolonged TTS recovered during the extended time to similar weight as at baseline (p = 0.131). The mean dysphagia score at the time of surgery improved significantly in both groups (p &lt; 0.001). There were no significant differences between patients allocated to standard versus prolonged TTS regarding postoperative complications, regardless of malnourishment status at baseline. No significant differences in OS after prolonged TTS compared to standard TTS, was observed in neither malnourished patients (hazard ratio, HR 1.72 (95 %, CI: 0.82–3.59, p = 0.147) nor non-malnourished patients (HR 1.26 (95 % CI:0.82–1.94, p = 0.291). Conclusions: Prolonged TTS was associated with better weight recovery at the time of surgery compared to standard TTS. Patients malnourished at baseline did not benefit in terms of less postoperative complications after prolonged TTS.</p>}},
  author       = {{Ericson, Jessica and Klevebro, Fredrik and Sunde, Berit and Szabo, Eva and Halldestam, Ingvar and Smedh, Ulrika and Wallner, Bengt and Johansson, Jan and Johnsen, Gjermund and Aahlin, Eirik Kjus and Johannessen, Hans Olaf and Hjortland, Geir Olav and Lorentzen, Sissi Stove and Slott, Malene and Schröder, Wolfgang and Rouvelas, Ioannis and Nilsson, Magnus}},
  issn         = {{0748-7983}},
  keywords     = {{Malnutrition; Neoadjuvant treatment; Oesophageal cancer; Postoperative outcomes; Time to surgery; Weight loss}},
  language     = {{eng}},
  number       = {{9}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Surgical Oncology}},
  title        = {{Nutritional outcomes and impact of malnutrition in a randomised comparison between standard and prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer}},
  url          = {{http://dx.doi.org/10.1016/j.ejso.2025.110228}},
  doi          = {{10.1016/j.ejso.2025.110228}},
  volume       = {{51}},
  year         = {{2025}},
}