Obesity and esophagectomy for esophageal cancer: is it only the high BMI that defines prognosis?

Obesity and esophagectomy for esophageal cancer: is it only the high BMI that defines prognosis? Diseases of the Esophagus (2018) 31,1 DOI: 10.1093/dote/doy014 Letters Obesity and esophagectomy for esophageal cancer: is it only the high BMI that defines prognosis? 1 1 2 1 D. I. Tsilimigras, D. Schizas, D. Moris, T. Liakakos First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece and Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, USA KEY WORDS: body mass index, esophageal cancer, esophagectomy, obesity. Dear Editor, it is the sarcopenic obesity that better predicts sur- We read with great interest the study entitled: vival. Sarcopenic obese patients may develop drug ‘The impact of obesity on esophagectomy: a meta- toxicity during neoadjuvant chemotherapy more fre- analysis,’ which showed that obese patients (body quently and this is associated with unfavorable out- mass index (BMI)≥ 30 kg/m ) from Western countries comes after resection of esophageal malignancies. with esophageal cancer undergoing esophagectomy, All in all, although the obesity paradox is often a although exhibiting an increased risk (about 35%) for reality with favorable outcomes in obese patients with anastomotic leak, tend to have a significantly higher some pathologies, this may be applicable for EAC, but 5-year survival (about 17%) compared to non-obese not for ESCC. 2 1 patients (BMI < 30 kg/m ). However, does this apply ACKNOWLEDGMENTS to all esophageal cancer types? Recently, Duan et al. found that obese patients 2 None. (BMI ≥ 27.5 kg/m ) with esophageal squamous cell carcinoma (ESCC) had a 5-year postesophagectomy Conflict of interest: None. survival of 20.8% compared to the 40.8% of the normal weight patients (P < 0.05). Another study 2 References showed that high BMI (BMI ≥ 25 kg/m )was adversely associated with overall survival (OS) and 1 Mengardo V, Pucetti F, Mc Cormack O, Chaudry A, Allum W H. The impact of obesity on esophagectomy: a meta-analysis. disease-free survival (DFS) in patients with ESCC fol- Dis Esophagus 2017. lowing esophagectomy in contrast to the normal BMI 2 Duan X F, Tang P, Shang X B, Jiang H J, Zhao Q, Yu Z T. High group, even after adjusting for age, sex, tumor stage, body mass index worsens survival in patients with esophageal squamous cell carcinoma after esophagectomy. Dig Surg 2017; and other comorbidities. Importantly, a meta-analysis 34: 724–30. of 14 studies showed that high BMI is an adverse prog- 3 WatanabeM,IshimotoT,BabaY et al. Prognostic impact of nostic factor for ESCC patients in terms of OS and body mass index in patients with squamous cell carcinoma of the esophagus. Ann Surg Oncol 2013; 20: 3984–91. DFS, despite being a predictor of better prognosis for 4 Pan W, Sun Z, Xiang Y, Fang W. The correlation between esophageal adenocarcinoma (EAC) patients. high body mass index and survival in patients with esophageal Evidence shows that the effects of the nutritional cancer after curative esophagectomy: evidence from retrospective studies. Asia Pac J Clin Nutr 2015; 24: 480–8. status on survival of esophageal cancer patients may 5 Anandavadivelan P, Brismar T B, Nilsson M, Johar A M, Martin be better explained by the muscle mass index rather L. Sarcopenic obesity: a probable risk factor for dose limiting tox- than the BMI. Of note, skeletal muscle loss is often icity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clin Nutr 2016; 35: 724–30. masked by sarcopenic obesity in these patients and Address correspondence to:: Diamantis I. Tsilimigras, MD, Clinical Research Fellow, First Department of Surgery, Laikon General Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece, 17 Ag. Thoma str., 11527 Athens, Greece. Email: tsilidiam@gmail.com The Author(s) 2018. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. Downloaded from https://academic.oup.com/dote/article-abstract/31/6/doy014/4924676 by Ed 'DeepDyve' Gillespie user All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1 on 20 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Diseases of the Esophagus Oxford University Press

Obesity and esophagectomy for esophageal cancer: is it only the high BMI that defines prognosis?

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The International Society for Diseases of the Esophagus
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© The Authors 2018. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus.
ISSN
1120-8694
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1442-2050
D.O.I.
10.1093/dote/doy014
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Abstract

Diseases of the Esophagus (2018) 31,1 DOI: 10.1093/dote/doy014 Letters Obesity and esophagectomy for esophageal cancer: is it only the high BMI that defines prognosis? 1 1 2 1 D. I. Tsilimigras, D. Schizas, D. Moris, T. Liakakos First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece and Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, USA KEY WORDS: body mass index, esophageal cancer, esophagectomy, obesity. Dear Editor, it is the sarcopenic obesity that better predicts sur- We read with great interest the study entitled: vival. Sarcopenic obese patients may develop drug ‘The impact of obesity on esophagectomy: a meta- toxicity during neoadjuvant chemotherapy more fre- analysis,’ which showed that obese patients (body quently and this is associated with unfavorable out- mass index (BMI)≥ 30 kg/m ) from Western countries comes after resection of esophageal malignancies. with esophageal cancer undergoing esophagectomy, All in all, although the obesity paradox is often a although exhibiting an increased risk (about 35%) for reality with favorable outcomes in obese patients with anastomotic leak, tend to have a significantly higher some pathologies, this may be applicable for EAC, but 5-year survival (about 17%) compared to non-obese not for ESCC. 2 1 patients (BMI < 30 kg/m ). However, does this apply ACKNOWLEDGMENTS to all esophageal cancer types? Recently, Duan et al. found that obese patients 2 None. (BMI ≥ 27.5 kg/m ) with esophageal squamous cell carcinoma (ESCC) had a 5-year postesophagectomy Conflict of interest: None. survival of 20.8% compared to the 40.8% of the normal weight patients (P < 0.05). Another study 2 References showed that high BMI (BMI ≥ 25 kg/m )was adversely associated with overall survival (OS) and 1 Mengardo V, Pucetti F, Mc Cormack O, Chaudry A, Allum W H. The impact of obesity on esophagectomy: a meta-analysis. disease-free survival (DFS) in patients with ESCC fol- Dis Esophagus 2017. lowing esophagectomy in contrast to the normal BMI 2 Duan X F, Tang P, Shang X B, Jiang H J, Zhao Q, Yu Z T. High group, even after adjusting for age, sex, tumor stage, body mass index worsens survival in patients with esophageal squamous cell carcinoma after esophagectomy. Dig Surg 2017; and other comorbidities. Importantly, a meta-analysis 34: 724–30. of 14 studies showed that high BMI is an adverse prog- 3 WatanabeM,IshimotoT,BabaY et al. Prognostic impact of nostic factor for ESCC patients in terms of OS and body mass index in patients with squamous cell carcinoma of the esophagus. Ann Surg Oncol 2013; 20: 3984–91. DFS, despite being a predictor of better prognosis for 4 Pan W, Sun Z, Xiang Y, Fang W. The correlation between esophageal adenocarcinoma (EAC) patients. high body mass index and survival in patients with esophageal Evidence shows that the effects of the nutritional cancer after curative esophagectomy: evidence from retrospective studies. Asia Pac J Clin Nutr 2015; 24: 480–8. status on survival of esophageal cancer patients may 5 Anandavadivelan P, Brismar T B, Nilsson M, Johar A M, Martin be better explained by the muscle mass index rather L. Sarcopenic obesity: a probable risk factor for dose limiting tox- than the BMI. Of note, skeletal muscle loss is often icity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clin Nutr 2016; 35: 724–30. masked by sarcopenic obesity in these patients and Address correspondence to:: Diamantis I. Tsilimigras, MD, Clinical Research Fellow, First Department of Surgery, Laikon General Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece, 17 Ag. Thoma str., 11527 Athens, Greece. Email: tsilidiam@gmail.com The Author(s) 2018. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. Downloaded from https://academic.oup.com/dote/article-abstract/31/6/doy014/4924676 by Ed 'DeepDyve' Gillespie user All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1 on 20 June 2018

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Diseases of the EsophagusOxford University Press

Published: Mar 7, 2018

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