The potential mechanisms of unintentional weight loss after oesophageal cancer surgery.

Abstract

Abstract Recent advances in the surgical and multimodality management of oesophageal cancer have led to improved survival for patients treated with curative intent. Survivors may struggle to adapt to the profound nutritional impact of oesophageal cancer surgery, and addressing dietary and related functional, and quality of life issues is an area of increased research focus. Mechanistic insight to explain significant weight loss has parallels in bariatric surgery. In particular, the gut-brain axis plays a pivotal role in energy balance and unintentional weight loss by influencing subconscious neural pathways, and key signalling pathways may be significantly altered in the context of major upper gastrointestinal surgery. In this review, we explore the core components comprising this gut-brain interplay, and outline the potential mechanisms underpinning the postoperative adaptations observed. We also discuss how this mechanism may affect weight and quality of life after oesophageal cancer resection. Only once the pathophysiological processes are understood are we likely to develop effective and sustainable therapeutic solutions.