Study On The Perioperative Nutritional Status Of Patients With Neoadjuvant Esophageal Cancer And Esophagogastric Junction Cancer

Objective: Understand the perioperative changes in the nutritional status of neoadjuvant esophageal cancer and esophagogastric junction cancer patients,analyze related factors,and provide evidence for improving the nutritional status of esophageal cancer and esophagogastric junction cancer patients during the perioperative period.Methods:The clinical medical records of these patients were collected through the electronic medical record system,and 128 patients with esophageal cancer in our department were retrospectively studied.Results: Compared with those before neoadjuvant treatment,PA levels increased significantly after neoadjuvant treatment(P<0.05),ALB,TP,and HGB levels decreased significantly(P<0.05),and weight,BMI,GLOB,and TLC decreased slightly,but all there was no statistical difference(P values were 0.43,0.73,0.23,0.14,respectively).The effect of neoadjuvant therapy on liver and kidney function in patients with esophageal cancer.Compared with before neoadjuvant therapy,ALT and AST levels were significantly increased after neoadjuvant therapy(P<0.05),Cr levels were significantly reduced(P<0.05),and UN levels were slightly reduced(P=0.52).Results of BMI evaluation: 57 patients(44.53%)were malnutrition before neoadjuvant treatment,and 58 patients(45.31%)were malnutrition after neoadjuvant treatment,compared with that before neoadjuvant therapy,the proportion of malnourished patients after neoadjuvant therapy increased slightly,but there was no statistical difference(P=0.90).Results of NRS2002 evaluation: 46patients(35.94%)had nutritional risk before neoadjuvant treatment,and 48patients(37.50%)had nutritional risk after neoadjuvant treatment,compared with that before neoadjuvant therapy,the proportion of nutritional risk after neoadjuvant therapy increased slightly,but there was no statistical difference(P=0.80).After neoadjuvant treatment,patients with esophageal cancer underwent surgery.Compared with before surgery,the levels of ALB,PA,TP,HGB,GLOB,TLC,body weight,and BMI of patients were significantly reduced after surgery,and the differences were statistically significant(all P<0.05);ALT and AST levels were significantly increased,and the difference was statistically significant(all P<0.05),and Cr and UN levels increased slightly,but there was no statistical difference(all P>0.05).After surgery,combined parenteral and enteral nutrition therapy and dietary education guidance were performed.Compared with the postoperative treatment,the patients’ ALB,PA,TP,GLOB,and TLC levels increased significantly after one month of enteral nutrition therapy,and the difference was statistically significant(all P<0.05);HGB increased slightly,but no statistical difference(P>0.05);body weight and BMI were significantly reduced(all P<0.05);ALT,AST,Cr,UN levels were significantly reduced(all P<0.05).Compared with before surgery,the GLOB level of patients increased significantly after enteral nutrition treatment one month after operation,the difference was statistically significant(P<0.05),there was no significant difference in TP and TLC levels(P>0.05),ALB,PA,HGB,body weight,and BMI levels were significantly reduced,and the difference was statistically significant(all P<0.05);ALT was not significantly different(P>0.05),AST levels were significantly increased(P<0.05),and Cr and UN levels were significantly reduced(P<0.05).Independent risk factor analysis indicated:independent risk factors for malnutrition after neoadjuvant therapy include: smoking,drinking,tumor location(middle/lower),BMI,NRS2002;independent risk factors for postoperative hypoproteinemia: female,drinking,neoadjuvant regimen chemotherapy;independent risk factors for postoperative pneumonia: smoking and Mckeown surgical approach;independent risk factors for postoperative anemia: smoking,pathological squamous cell carcinoma,the lower part of the tumor location.Conclusions:Neoadjuvant therapy significantly increased PA levels in patients with esophageal cancer.During neoadjuvant therapy,attention should be paid to the levels of ALB,TP and HGB,and attention should be paid to the impact on liver and kidney function.The proportion of malnutrition and nutritional risk in patients with esophageal cancer after neoadjuvant therapy no increase.Surgical treatment after neoadjuvant treatment seriously damages the nutritional status of patients with esophageal cancer,and postoperative nutritional therapy is extremely critical.From the independent risk factor analysis,it can be seen that the women,and patients with tumors in the middle and lower segments are more likely to suffer from malnutrition.Patients should be encouraged to quit smoking and alcohol,and nutritional intervention should be given as soon as possible.In short,for neoadjuvant perioperative esophageal cancer patients,especially esophageal cancer patients with high risk factors for malnutrition,the nutritional status of the patients should be closely monitored and effective nutritional treatment measures should be taken in time.