# Nutritional aspects and quality of life in gastroesophageal cancer patients that underwent colonic interposition

## TL;DR

This study examines the nutritional and quality of life outcomes in cancer patients who had a colonic interposition after esophageal surgery.

## Contribution

The study provides new insights into gastrointestinal symptoms, malabsorption, and quality of life after colonic interposition in gastroesophageal cancer patients.

## Key findings

- Most patients experienced symptoms like steatorrhea and dysphagia after the procedure.
- A significant proportion of patients had fat and protein malabsorption and negative energy balance.
- Quality of life scores were moderate, indicating room for improvement in post-surgery care.

## Abstract

The use of a colonic interposition after major esophageal surgery leads to substantial anatomical changes, but information regarding the effects of these changes on functional outcomes is limited. Objective of this study was to evaluate the presence of gastrointestinal symptoms, nutritional aspects, intestinal absorption capacity, and health-related quality of life (HR-QoL) in adult patients after colon interposition. This single-center study consisted of three parts. Part 1 involved a retrospective review of anthropometric data, dietary patterns, and gastrointestinal symptoms in all consecutive patients who underwent colonic interposition between 2010 and 2021 and in whom at least 6 months of follow-up were available. Patients from part 1 who were still alive in 2021 were invited for an in-depth evaluation of dietary intake and intestinal absorption capacity. This included measuring daily fecal losses of energy (kcal), fat (g), and protein (g) over a 72-hour period. The coefficients of fat and protein absorption (CFA and CNA) were calculated. Energy balance (kcal/day) was determined by subtracting fecal energy loss (kcal/day) and daily estimated total energy expenditure (eTEE) from the dietary energy intake (kcal/day). Part 3 assessed HR-QoL prospectively using the EORTC QLQ-C30 and OG-25 questionnaires. All consecutive patients presenting to the outpatient clinic between 2014 and 2021 were asked to complete these questionnaires. In part 1 of this study, 30 patients were included. Symptoms of steatorrhea/diarrhea (65%) and dysphagia (42%) were most frequently reported, and 31% could not cease enteral nutrition via jejunostomy or nasal tube due to weight loss or gastrointestinal symptoms. Ten patients were included in part 2 of this study. Intestinal malabsorption of fat and protein (CFA and CNA <85%) was found in 70% of patients, and 60% of patients had a negative energy balance. HR-QoL was measured in 20 patients. Median global QoL score (EORTC QLQ-C30) was 63 (IQR 50-83) and the OG-25 symptom score 19 (IQR 6.9–36). In conclusion a colonic interposition after esophagectomy is accompanied by gastrointestinal symptoms, intestinal malabsorption, and an impaired QoL. Adequate counseling of patients and follow-up with a multidisciplinary approach to treat gastrointestinal symptoms and correct for intestinal malabsorption is recommended.