Abstract
Background
The long-term impact of preoperative treatment on nutritional recovery after esophagectomy remains unclear. Although neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (NACRT) followed by surgery are established strategies for advanced esophageal cancer, their differential effects on postoperative weight loss have not been well characterized. This study aimed to compare long-term nutritional outcomes between esophagectomy after induction chemotherapy and after induction chemoradiotherapy in patients with T4b esophageal cancer.Methods
We retrospectively analyzed 86 patients with T4b esophageal cancer who underwent conversion surgery after induction treatment at six institutions between 2009 and 2021. Patients were categorized into a chemotherapy group (CT group, n = 51) and a chemoradiotherapy group (CRT group, n = 35). Longitudinal changes in body weight, lymphocyte counts, serum albumin levels, and prognostic nutritional index (PNI) were evaluated up to 24 months postoperatively.Results
Postoperative weight loss was significantly greater in the CRT group than in the CT group, particularly at 9 and 12 months postoperatively (-13.4% vs. -9.6%, P = 0.011; -13.8% vs. -9.3%, P = 0.022). Weight loss persisted until 12 months after esophagectomy in the CRT group, whereas gradual recovery was observed after 6 months in the CT group. Lymphocyte counts were consistently lower in the CRT group from preoperation through 24 months postoperatively (all P Conclusions
Esophagectomy following induction chemoradiotherapy was associated with greater long-term weight loss and impaired nutritional recovery compared with surgery following chemotherapy alone. These findings highlight the need for intensified nutritional surveillance and intervention in patients treated with preoperative CRT.