Skip to main content

Advertisement

SpringerLink
Log in

Perioperative body composition changes in the multimodal treatment of gastrointestinal cancer

  • Review Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Surgical resection and perioperative adjuvant therapy are widely accepted standard treatments for gastrointestinal cancer. However, body composition changes, such as weight loss and skeletal muscle loss, are unavoidable during these treatments. Several studies have shown that perioperative body composition changes are affected by multimodal treatment for gastrointestinal cancer. This review summarizes the background, current status, and future perspectives of perioperative body composition changes in the multimodal treatment of gastrointestinal cancer. Recent studies have described the body composition changes observed in the early period after surgery and during adjuvant therapy. Changes in the body composition might affect adjuvant chemotherapy toxicity after surgery and postoperative complications after neoadjuvant therapy. The mechanisms underlying body composition changes during multimodal therapy are multifactorial and include systemic inflammation, reduced nutrient intake, and physical inactivity. Several approaches have been tested to maintain the body composition, and especially prevent skeletal muscle wasting, during multimodal therapy. Although the ideal approach for managing body composition changes in gastrointestinal cancer patients remains unclear, recent studies support the combination of multiple approaches rather than a single approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.

    Article  Google Scholar 

  2. Yoshikawa T, Rino Y, Yukawa N, Oshima T, Tsuburaya A, Masuda M. Neoadjuvant chemotherapy for gastric cancer in Japan: a standing position by comparing with adjuvant chemotherapy. Surg Today. 2014;44:11–21.

    Article  CAS  Google Scholar 

  3. NCCN. NCCN Clinical Practice Guidelines in Oncology. 2018; https://www.nccn.org.

  4. Okines A, Verheij M, Allum W, Cunningham D, Cervantes A, and the ESMO Guidelines Working Group. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010;21 (suppl 5):v50– v 54.

  5. Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, et al. Postoperative changes in body composition after gastrectomy. J Gastrointest Surg. 2005;9:313–9.

    Article  Google Scholar 

  6. Cruickshank AM, Fraser WD, Burns HJ, Van Damme J, Shenkin A. Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci. 1990;79:161–5.

    Article  CAS  Google Scholar 

  7. Mansoor O, Beaufrere B, Boirie Y, Ralliere C, Taillandier D, Aurousseau E, et al. Increased mRNA levels for components of the lysosomal Ca2 activated, and ATP-ubiquitin-dependent proteolytic pathways in skeletal muscle from head trauma patients. Proc Natl Acad Sci. 1996;93:2714–8.

    Article  CAS  Google Scholar 

  8. Tiao G, Hobler S, Wang JJ, Meyer TA, Luchette FA, Fischer JE, et al. Sepsis is associated with increased mRNAs of the 1iquitin-proteasome proteolytic pathway in human skeletal muscle. J Clin Invest. 1997;99:163–8.

    Article  CAS  Google Scholar 

  9. Adams JF. The clinical and metabolic consequences of total gastrectomy. I. Morbidity, weight, and nutrition. Scand J Gastroenterol 1967;2:137–49.

    Article  CAS  Google Scholar 

  10. Fein M, Fuchs KH, Thalheimer A, Freys SM, Heimbucher J, Thiede A. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg. 2008;247:759–65.

    Article  Google Scholar 

  11. Ida S, Hiki N, Cho H, Sakamaki K, Ito S, Fujitani K, et al. Randomized clinical trial comparing standard diet with perioperative oral immunonutrition in total gastrectomy for gastric cancer. Br J Surg. 2017;104:377–83.

    Article  CAS  Google Scholar 

  12. Aoyama T, Kawabe T, Hirohito F, Hayashi T, Yamada T, Tsuchida K, et al. Body composition analysis within 1 month after gastrectomy for gastric cancer. Gastric Cancer. 2016;19:645–50.

    Article  Google Scholar 

  13. Jensen MB, Houborg KB, Nørager CB, Henriksen MG, Laurberg S. Postoperative changes in fatigue, physical function and body composition: an analysis of the amalgamated data from five randomized trials on patients undergoing colorectal surgery. Colorectal Dis. 2011;13:588–93.

    Article  CAS  Google Scholar 

  14. Aoyama T, Yoshikawa T, Shirai J, Hayashi T, Yamada T, Tsuchida K, et al. Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol. 2013;20:2000–6.

    Article  Google Scholar 

  15. Prado CM, Baracos VE, McCargar LJ, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007;13:3264–8.

    Article  CAS  Google Scholar 

  16. Prado CM, LieffersJR,McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patientswith solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 2008;9:629–35.

    Article  Google Scholar 

  17. Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, et al. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009;15:2920–6.

    Article  CAS  Google Scholar 

  18. Aoyama T, Kawabe T, Fujikawa H, Hayashi T, Yamada T, Tsuchida K, et al. Loss of Lean Body Mass as an Independent Risk Factor for Continuation of S-1 Adjuvant Chemotherapy for Gastric Cancer. Ann Surg Oncol. 2015;22:2560–6.

    Article  Google Scholar 

  19. Prado CM, Baracos VE, McCargar LJ, Mourtzakis M, Mulder KE, Reiman T, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007;13:3264–8.

    Article  CAS  Google Scholar 

  20. Awad S, Tan BH, Cui H, Bhalla A, Fearon KC, Parsons SL, et al. Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer. Clin Nutr. 2012;31:74–7.

    Article  Google Scholar 

  21. Reisinger KW, Bosmans JW, Uittenbogaart M, Alsoumali A, Poeze M, Sosef MN, et al. Loss of Skeletal Muscle Mass During Neoadjuvant Chemoradiotherapy Predicts Postoperative Mortality in Esophageal Cancer Surgery. Ann Surg Oncol. 2015;22:4445–52.

    Article  Google Scholar 

  22. Yip C, Goh V, Davies A, Gossage J, Mitchell-Hay R, Hynes O, et al. Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer. Eur Radiol. 2014;24:998–1005.

    Article  Google Scholar 

  23. Elliott JA, Doyle SL, Murphy CF, King S, Guinan EM, Beddy P, et al. Sarcopenia: Prevalence, and Impact on Operative and Oncologic Outcomes in the Multimodal Management of Locally Advanced Esophageal Cancer. Ann Surg. 2017;266:822–30.

    Article  Google Scholar 

  24. Cooper AB, Slack R, Fogelman D, Holmes HM, Petzel M, Parker N, et al. Characterization of Anthropometric Changes that Occur During Neoadjuvant Therapy for Potentially Resectable Pancreatic Cancer. Ann Surg Oncol. 2015;22:2416–23.

    Article  Google Scholar 

  25. Motoori M, Fujitani K, Sugimura K, Miyata H, Nakatsuka R, Nishizawa Y, et al. Skeletal Muscle Loss during Neoadjuvant Chemotherapy Is an Independent Risk Factor for Postoperative Infectious Complications in Patients with Advanced Esophageal Cancer. Oncology. 2018;95:281–7.

    Article  Google Scholar 

  26. Eriksson S, Nilsson JH, Strandberg Holka P, Eberhard J, Keussen I, Sturesson C. The impact of neoadjuvant chemotherapy on skeletal muscle depletion and preoperative sarcopenia in patients with resectable colorectal liver metastases. HPB (Oxford). 2017;19:331–7.

    Article  Google Scholar 

  27. Braga M, Gianotti L, Vignali A, Carlo VD. Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery. 2002;132:805–14.

    Article  Google Scholar 

  28. Rice TW, Wheeler AP, Thompson BT, deBoisblanc BP, Steingrub J, Rock P. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306:1574–81.

    Article  CAS  Google Scholar 

  29. Ryan AM, Reynolds JV, Healy L, Byrne M, Moore J, Brannelly N, et al. Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: results of a double-blinded randomized controlled trial. Ann Surg. 2009;249:355–63.

    Article  Google Scholar 

  30. Healy LA, Ryan A, Doyle SL, Ní Bhuachalla ÉB, Cushen S, Segurado R, et al. Does prolonged enteral feeding with supplemental omega-3 fatty acids impact on recovery post-esophagectomy: results of a randomized double-blind trial. Ann Surg. 2017;266:720–8.

    Article  Google Scholar 

  31. Imamura H, Nishikawa K, Kishi K, Inoue K, Matsuyama J, Akamaru Y, et al. Effects of an oral elemental nutritional supplement on post-gastrectomy body weight loss in gastric cancer patients: a randomized controlled clinical trial. Ann Surg Oncol. 2016;23:2928–35.

    Article  Google Scholar 

  32. Hatao F, Chen KY, Wu JM, Wang MY, Aikou S, Onoyama H, et al. Randomized controlled clinical trial assessing the effects of oral nutritional supplements in postoperative gastric cancer patients. Langenbecks Arch Surg. 2017;402:203–11.

    Article  Google Scholar 

  33. Yamamoto K, Nagatsuma Y, Fukuda Y, Hirao M, Nishikawa K, Miyamoto A, et al. Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer. Gastric Cancer. 2017;20:913–8.

    Article  Google Scholar 

  34. Yamada T, Hayashi T, Cho H, Yoshikawa T, Taniguchi H, Fukushima R, Tsuburaya A. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer. 2012;15:34–41.

    Article  Google Scholar 

  35. Tanaka R, Lee SW, Kawai M, Tashiro K, Kawashima S, Kagota S, Honda K, Uchiyama K. Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial. Gastric Cancer. 2017; 20:861–871.

    Article  Google Scholar 

  36. Gillis C, Fenton TR, Sajobi TT, Minnella EM, Awasthi R, Loiselle SÈ, Liberman AS, Stein B, Charlebois P, Carli F. Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. Clin Nutr. 2018;S0261–5614:31201–9.

  37. Ida S, Watanabe M, Karashima R, Imamura Y, Ishimoto T, Baba Y, et al. Changes in body composition secondary to neoadjuvant chemotherapy for advanced esophageal cancer are related to the occurrence of postoperative complications after esophagectomy. Ann Surg Oncol. 2014;21:3675–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Toru Aoyama

Authors
  1. Toru Aoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toru Aoyama.

Ethics declarations

Conflict of interest

Toru Aoyama has no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aoyama, T. Perioperative body composition changes in the multimodal treatment of gastrointestinal cancer. Surg Today 50, 217–222 (2020). https://doi.org/10.1007/s00595-019-01815-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-019-01815-8

Keywords

Search

Navigation