Nutritional Outcomes and Impact of Malnutrition in a Randomized Comparison Between Standard and Prolonged Time to Surgery After Neoadjuvant Chemoradiotherapy for Esophageal Cancer

Background Prolonged time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) may enable malnourished oesophageal cancer patients´ nutritional status to recover better, possibly improving outcomes after esophagectomy. Methods This is a substudy within a randomised multicenter controlled trial comparing outcomes in esophageal cancer patients after standard TTS of 4-6 weeks to prolonged TTS of 10-12 weeks after nCRT. Patients were categorized as malnourished or non-malnourished at baseline and compared regarding nutritional endpoints. Results The mean weight decreased significantly from baseline to the standard TTS (p<0.001) while at the prolonged TTS it had recovered to baseline level (p=0.131), Figure 1. There was no significant difference in postoperative complications between patients malnourished at baseline when allocated to standard compared to delayed surgery (OR: 0.90, 95% confidence interval, CI: 0.29-2.77 and OR 1.13, 95% CI: 0.32-4.00, respectively). Patients malnourished at baseline had a strong trend to worse survival after delayed compared to standard TTS, Hazard ratio (HR) 1.72 (95%, CI: 0.82-3.59, p=0.147). which was less pronounced for non-malnourished patients, HR 1.26 (95% CI:0.82-1.94, p=0.291). Conclusions Prolonged TTS led to better weight recovery at time of surgery. Patients malnourished at baseline did not benefit in terms of less postoperative morbidity after delayed surgery and had a stronger trend to detriment in survival from delayed surgery than non-malnourished patients.