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A retrospective study of preoperative malnutrition based on the Controlling Nutritional Status score as an associated marker for short-term outcomes after open and minimally invasive esophagectomy for esophageal cancer

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Abstract

Purpose

Preoperative malnutrition is a significant risk factor for post-esophagectomy morbidity. The Controlling Nutritional Status (CONUT) is an index used to assess nutritional status, and it has been suggested to predict post-esophagectomy morbidity. However, the difference in the predictive value of CONUT in estimating morbidities between open esophagectomy (OE) and minimally invasive esophagectomy (MIE) has not yet been elucidated.

Methods

This study included patients who underwent a three-incision esophagectomy for esophageal cancer between April 2005 and August 2021. The patients were further divided into two groups according to their preoperative CONUT scores: normal and light malnutrition and moderate and severe malnutrition. Short-term outcomes between these groups were retrospectively compared in the OE and MIE groups.

Results

A total of 674 patients who underwent OE (296) and MIE (378) were analyzed. Moreover, 32 patients of the OE group and 16 of the MIE group were classified as having moderate and severe malnutrition, respectively. Moderate and severe malnutrition was significantly associated with a low body mass index, poor performance status, poor American Society of Anesthesiologists physical status, advanced cancer stage, and frequent preoperative treatment. These patients also experienced significantly more frequent morbidities of grade ≥ IIIb according to the Clavien–Dindo classification (CDc), respiratory, and cardiovascular morbidities after OE. Moreover, moderate and severe malnutrition in CONUT was an independent risk factor for morbidity of CDc ≥ IIIb (odds ratio [OR] vs. normal and light malnutrition = 3.38; 95% confidence interval [CI], 1.225–9.332; p = 0.019), respiratory (OR = 3.00; 95% CI, 1.161–7.736; p = 0.023), and cardiovascular morbidities (OR = 3.66; 95% CI, 1.068–12.55; p = 0.039) after OE. Meanwhile, moderate and severe malnutrition in CONUT did not increase the incidence of postoperative morbidities after MIE.

Conclusion

Preoperative malnutrition in CONUT reflects various disadvantageous clinical factors and could be a predictor of worse short-term outcomes after OE, but it has no value in MIE. The low invasiveness of MIE might reduce the effect of preoperative malnutrition on worse short-term outcomes.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan

    Tomo Horinouchi, Naoya Yoshida, Kazuto Harada, Kojiro Eto, Hiroshi Sawayama, Masaaki Iwatsuki, Shiro Iwagami, Yoshifumi Baba, Yuji Miyamoto & Hideo Baba

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  1. Tomo Horinouchi
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Contributions

Tomo Horinouchi described and designed the article. Naoya Yoshida edited the article. Hideo Baba supervised the editing of the manuscript. Tomo Horinouchi, Naoya Yoshida, Kazuto Harada, Kojiro Eto, Masaaki Iwatsuki, and Yoshifumi Baba contributed to material preparation, data collection, and analysis. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hideo Baba.

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This study was conducted in accordance with the ethical standards of the Declaration of Helsinki 1975. The institutional ethics committee approved all the research procedures (Registration No. 1909) and waived the requirement for written informed consent owing to the retrospective nature of the study.

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Horinouchi, T., Yoshida, N., Harada, K. et al. A retrospective study of preoperative malnutrition based on the Controlling Nutritional Status score as an associated marker for short-term outcomes after open and minimally invasive esophagectomy for esophageal cancer. Langenbecks Arch Surg 407, 3367–3375 (2022). https://doi.org/10.1007/s00423-022-02655-w

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