411. IMPACT OF FEEDING ADJUNCTS AND RADIOLOGICAL SARCOPENIA ON OUTCOMES IN NEO-ADJUVANT TREATED OESOPHAGEAL CANCER PATIENTS

Abstract

Abstract Introduction Nutritional management plays a pivotal role in the care of patients with oesophageal cancer, particularly for those presenting with complete dysphagia, which poses a significant management challenge. Establishing adequate nutrition is not only a prerequisite for initiating neo-adjuvant treatment in cases of potentially curable disease but is also crucial for patient survival and quality of life. Additionally, emerging evidence suggests that sarcopenia, significantly predicts post-operative complications following oesophageal surgery. Our study aims to evaluate the impact of feeding adjuncts during neo-adjuvant treatment on outcomes, including post-operative complications, and to investigate the prevalence and implications of radiological sarcopenia in these patients. Methods Data from the Northern Oesophago-Gastric Cancer Unit database was used to identify patients diagnosed with oesophageal cancer and discussed at the multidisciplinary team (MDT) meetings from 2017 to 2021. The focus was on those deemed curable with planned neo-adjuvant treatment followed by surgery. Through MDT notes review, patients were identified that required feeding adjuncts prior to surgery. Demographics, tumour characteristics, treatment modalities, hospital stay length, complication rates, and survival outcomes were collected. Radiological sarcopenia was evaluated at initial staging and re-staging computed tomography (CT) scans. Results 353 patients were included; 15 required pre-operative feeding adjuncts. This subgroup was predominantly male (73%), with a higher proportion having squamous cell carcinoma (SCC) (34% V 17%). Progression to surgery was lower in the adjunct group (73% V 87%, p=0.11). Post-operative hospital stay and one-year survival rates were comparable between groups. The adjunct group had a higher incidence of severe post-operative complications (50% Vs 28% Clavien-Dindo grade ≥3, p=0.08). Radiological sarcopenia was higher in the adjunct group (70% Vs 52%, p=0.18), with no cases of sarcopenia reversal after re-staging in the adjunct group, versus 9% in the non-adjunct group. Conclusion These findings highlight an association between complete dysphagia in patients with potentially curable oesophageal cancer and increased rates of post-operative complications and pre-operative radiological sarcopenia. Notably, these patients are more likely to be female and have SCC. The data underscore the critical need for diligent monitoring and nutritional support for patients requiring feeding adjuncts in the neo-adjuvant phase, emphasizing the broader implications of nutritional status on surgical outcomes and overall patient care in oesophageal cancer management.