Characteristics and influencing factors of postoperative weight change in patients with esophageal cancer: A prospective longitudinal study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Chengxiang ¹ , YANG Yang ² , ZHANG Tian ³ , XIE Ruonan ¹ , JIANG Xin ¹ , LENG Yingjie ¹ , NIE Zhuomiao ¹ ,  WANG Guorong ³

1. School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P. R. China;
2. Institute of Integrated Traditional Chinese and Western Medicine/West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Nursing, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610042, P. R. China;

Corresponding author：

WANG Guorong, Email: guorong_wang@uestc.edu.cn

Keywords：

Esophageal cancer; surgical patients; changes in body weight; longitudinal study

DOI：

10.7507/1007-4848.202401016

Video：

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Objective To longitudinally investigate the characteristics of postoperative weight changes in patients with esophageal cancer and analyze its influencing factors, which can provide certain guidance for nutritional intervention in patients with esophageal cancer. Methods Patients with esophageal cancer who underwent surgical treatment at the Sichuan Cancer Hospital from December 2020 to February 2022 were prospectively included. The general information questionnaire and body composition analyzer were used to longitudinally investigate the patients’ weight and body composition before surgery (T0), 1 month after surgery (T1), 3 months after surgery (T2) and 6 months after surgery (T3), and the change characteristics were analyzed. The generalized estimating equation was used to analyze the influencing factors for postoperative weight changes in patients with esophageal cancer. Results A total of 130 patients were enrolled, including 110 males and 20 females, aged 42-79 (63.33±8.16) years. The weight and body composition of patients with esophageal cancer showed a continuous slow downward trend within 6 months after surgery. The weight loss rate of patients at 1, 3, and 6 months after surgery was 5.10%, 7.76%, and 9.86%, respectively. At the same time, the analysis results of the influencing factors for postoperative weight showed that patients with the following characteristics had more weight loss: female (β=−7.703, P=0.001), ≥60 years (β=−3.657, P=0.010), smoking (β=4.622, P=0.010), low tumor differentiation degree (β=4.314, P=0.039), and high frequency of eating (β=−3.400, P=0.008). Conclusion Weight loss is an important health problem for patients with esophageal cancer after surgery, and patients have a continuous downward trend in weight within 6 months after surgery. Medical staff should pay special attention to the patients who are female, ≥60 years, having smoking history and low tumor differentiation degree.

1.	杨天硕, 李可心, 单保恩. 食管癌免疫治疗研究进展. 中国肿瘤生物治疗杂志, 2021, 28(12): 1207-1214.
2.	Kamangar F, Nasrollahzadeh D, Safiri S, et al. The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol, 2020, 5(6): 582-597.
3.	Martin-Richard M, Díaz Beveridge R, Arrazubi V, et al. SEOM clinical guideline for the diagnosis and treatment of esophageal cancer (2016). Clin Transl Oncol, 2016, 18(12): 1179-1186.
4.	Koterazawa Y, Oshikiri T, Takiguchi G, et al. Severe weight loss after minimally invasive oesophagectomy is associated with poor survival in patients with oesophageal cancer at 5 years. BMC Gastroenterol, 2020, 20(1): 407.
5.	Carr RA, Harrington C, Stella C, et al. Early implementation of a perioperative nutrition support pathway for patients undergoing esophagectomy for esophageal cancer. Cancer Med, 2022, 11(3): 592-601.
6.	Clavier JB, Antoni D, Atlani D, et al. Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer. Dis Esophagus, 2014, 27(6): 560-567.
7.	Quyen TC, Angkatavanich J, Thuan TV, et al. Nutrition assessment and its relationship with performance and Glasgow prognostic scores in Vietnamese patients with esophageal cancer. Asia Pac J Clin Nutr, 2017, 26(1): 49-58.
8.	徐秀娟, 杨帆, 蒋淑年, 等. 营养风险对老年早期食管癌患者放疗的预后的影响. 肿瘤学杂志, 2018, 24(9): 866-870.
9.	Gellrich NC, Handschel J, Holtmann H, et al. Oral cancer malnutrition impacts weight and quality of life. Nutrients, 2015, 7(4): 2145-2160.
10.	Pressoir M, Desné S, Berchery D, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer, 2010, 102(6): 966-971.
11.	Fukuda Y, Yamamoto K, Hirao M, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol, 2015, 22 Suppl 3: S778-S785.
12.	Álvaro Sanz E, Garrido Siles M, Rey Fernández L, et al. Nutritional risk and malnutrition rates at diagnosis of cancer in patients treated in outpatient settings: Early intervention protocol. Nutrition, 2019, 57: 148-153.
13.	Zhang L, Lu Y, Fang Y. Nutritional status and related factors of patients with advanced gastrointestinal cancer. Br J Nutr, 2014, 111(7): 1239-1244.
14.	Fujisawa K, Ohkura Y, Ueno M, et al. Nutritional outcomes of thoracic duct resection for radical esophagectomy by assessing body composition changes in one year: A single-center retrospective study. Ann Surg Oncol, 2021, 28(13): 8414-8425.
15.	王艳莉, 辛晓伟, 周秀耕, 等. 食管癌手术病人相位角与营养状况的相关性研究. 肠外与肠内营养, 2019, 26(2): 65-69.
16.	Movahed S, Varshoee Tabrizi F, Pahlavani N, et al. Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: A cross-sectional study. Clin Nutr, 2021, 40(6): 4449-4455.
17.	Kubo Y, Miyata H, Sugimura K, et al. Prognostic implication of postoperative weight loss after esophagectomy for esophageal squamous cell cancer. Ann Surg Oncol, 2021, 28(1): 184-193.
18.	Ericson J, Lundell L, Lindblad M, et al. Assessment of energy intake and total energy expenditure in a series of patients who have undergone oesophagectomy following neoadjuvant treatment. Clin Nutr ESPEN, 2020, 37: 121-128.
19.	Ludwig DJ, Thirlby RC, Low DE. A prospective evaluation of dietary status and symptoms after near-total esophagectomy without gastric emptying procedure. Am J Surg, 2001, 181(5): 454-458.
20.	Okabe H, Tsunoda S, Sunagawa H, et al. A long-term follow-up study of minimally invasive Ivor Lewis esophagectomy with linear stapled anastomosis. Surg Endosc, 2022, 36(3): 1979-1988.
21.	Miyazaki T, Tanaka N, Hirai H, et al. Ghrelin level and body weight loss after esophagectomy for esophageal cancer. J Surg Res, 2012, 176(1): 74-78.
22.	Murphy CF, Fanning M, Raftery N, et al. Early experience with a nutrition and survivorship clinic in esophageal cancer. Dis Esophagus, 2021, 34(2): doaa061.
23.	雷海科, 廖忠莉, 李小升, 等. 重庆市食管癌患者生存随访调查及预后影响因素研究. 中国癌症杂志, 2020, 30(2): 98-105.
24.	Finley FJ, Lamy A, Clifton J, et al. Gastrointestinal function following esophagectomy for malignancy. Am J Surg, 1995, 169(5): 471-475.
25.	McLarty AJ, Deschamps C, Trastek VF, et al. Esophageal resection for cancer of the esophagus: Long-term function and quality of life. Ann Thorac Surg, 1997, 63(6): 1568-1572.
26.	Cao J, Xu H, Li W, et al. Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer. Curr Probl Cancer, 2021, 45(1): 100638.
27.	Martin L, Jia C, Rouvelas I, et al. Risk factors for malnutrition after oesophageal and cardia cancer surgery. Br J Surg, 2008, 95(11): 1362-1368.
28.	Shim H, Cheong JH, Lee KY, et al. Perioperative nutritional status changes in gastrointestinal cancer patients. Yonsei Med J, 2013, 54(6): 1370-1376.
29.	张芳. 贫血、吸烟、饮酒、体重指数与食管鳞癌预后关系的临床研究. 山东大学, 2014.
30.	He Y, Liang D, Du L, et al. Clinical characteristics and survival of 5283 esophageal cancer patients: A multicenter study from eighteen hospitals across six regions in China. Cancer Commun (Lond), 2020, 40(10): 531-544.
31.	刘阳阳. 循环肿瘤细胞、中性粒细胞淋巴细胞比值及体重指数对局部晚期食管鳞癌患者预后评估中的临床价值. 吉林医学, 2022, 43(3): 796-799.
32.	罗越魁, 王成, 孟于琪, 等. 体重指数与食管鳞状细胞癌切除术后转归及总生存率关系的研究. 中国胸心血管外科临床杂志, 2016, 23(5): 467-471.
33.	Garcidueñas-Fimbres TE, Paz-Graniel I, Nishi SK, et al. Eating speed, eating frequency, and their relationships with diet quality, adiposity, and metabolic syndrome, or its components. Nutrients, 2021, 13(5): 1687.Garcidueñas-Fimbres TE, Paz-Graniel I, Nishi SK, et al. Eating speed, eating frequency, and their relationships with diet quality, adiposity, and metabolic syndrome, or its components. Nutrients, 2021, 13(5): 1687.
34.	Zhu Y, Hollis JH. Associations between eating frequency and energy intake, energy density, diet quality and body weight status in adults from the USA. Br J Nutr, 2016, 115(12): 2138-2144.Zhu Y, Hollis JH. Associations between eating frequency and energy intake, energy density, diet quality and body weight status in adults from the USA. Br J Nutr, 2016, 115(12): 2138-2144.
35.	Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN guidelines on enteral nutrition: Terminology, definitions and general topics. Clin Nutr, 2006, 25(2): 180-186.
36.	Parsons EL, Stratton RJ, Cawood AL, et al. Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents. Clin Nutr, 2017, 36(1): 134-142.
37.	石海燕, 陈宏林, 吴超, 等. 口服营养补充对食管癌根治术后出院患者营养状况影响的研究. 中国现代医生, 2021, 59(11): 176-179.
38.	吴启润, 罗婷, 王鹏. 营养支持方式在肿瘤晚期患者中应用现状及展望. 实用肿瘤学杂志, 2018, 32(4): 381-384.
39.	贾震易. 家居肿瘤患者的口服营养补充. 肿瘤代谢与营养电子杂志, 2015(1): 19-22.
40.	杜小萍, 吕冬宁. 低磷饮食干预对肾衰竭血液透析病人营养状况、心理状况、血磷、血糖管理的影响. 护理研究, 2016, 30(29): 3636-3639.
41.	Yang L, Gao J, Zhou Y, et al. Effect of oral nutritional supplements on patients with esophageal cancer during radiotherapy. Cancer Biother Radiopharm, 2023, 38(2): 89-94.
42.	Xie H, Chen X, Xu L, et al. A randomized controlled trial of oral nutritional supplementation versus standard diet following McKeown minimally invasive esophagectomy in patients with esophageal malignancy: A pilot study. Ann Transl Med, 2021, 9(22): 1674.
43.	Baldwin C, Spiro A, Ahern R, et al. Oral nutritional interventions in malnourished patients with cancer: A systematic review and meta-analysis. J Natl Cancer Inst, 2012, 104(5): 371-385.
44.	杨雪蓝, 吴沛霞, 席淑新, 等. 头颈癌病人围术期去脂体重丢失情况及影响因素分析. 护理研究, 2020, 34(24): 4356-4361.
45.	王家成, 孙琳, 张献娜, 等. GLIM标准下胃肠道恶性肿瘤手术患者营养状况调查及发生营养不良的影响因素分析. 现代肿瘤医学, 2023, 31(17): 3216-3221.
46.	高文华. 鼻咽癌放疗术后吞咽障碍患者营养风险指数状况及其相关因素分析. 中国医学文摘(耳鼻咽喉科学), 2023, 38(5): 12-16.
47.	徐国英, 魏娟青. 肺癌患者放疗期间发生营养不良的危险因素分析及护理. 全科医学临床与教育, 2022, 20(5): 477-478.
48.	周欣, 程敏琼, 黄晓萍, 等. 恶性肿瘤患者放疗期间营养不良发生及危险因素分析. 国际老年医学杂志, 2021, 42(4): 203-207, 234.
49.	Grace EM, Shaw C, Lalji A, et al. Nutritional status, the development and persistence of malnutrition and dietary intake in oesophago-gastric cancer: A longitudinal cohort study. J Hum Nutr Diet, 2018, 31(6): 785-792.
50.	Martin L, Findlay M, Bauer JD, et al. A multi-site, international audit of malnutrition risk and energy and protein intakes in patients undergoing treatment for head neck and esophageal cancer: Results from INFORM. Nutrients, 2022, 14(24): 5272.
51.	Lidoriki I, Schizas D, Mylonas KS, et al. Postoperative changes in nutritional and functional status of gastroesophageal cancer patients. J Am Nutr Assoc, 2022, 41(3): 301-309.

1. 杨天硕, 李可心, 单保恩. 食管癌免疫治疗研究进展. 中国肿瘤生物治疗杂志, 2021, 28(12): 1207-1214.
2. Kamangar F, Nasrollahzadeh D, Safiri S, et al. The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol, 2020, 5(6): 582-597.
3. Martin-Richard M, Díaz Beveridge R, Arrazubi V, et al. SEOM clinical guideline for the diagnosis and treatment of esophageal cancer (2016). Clin Transl Oncol, 2016, 18(12): 1179-1186.
4. Koterazawa Y, Oshikiri T, Takiguchi G, et al. Severe weight loss after minimally invasive oesophagectomy is associated with poor survival in patients with oesophageal cancer at 5 years. BMC Gastroenterol, 2020, 20(1): 407.
5. Carr RA, Harrington C, Stella C, et al. Early implementation of a perioperative nutrition support pathway for patients undergoing esophagectomy for esophageal cancer. Cancer Med, 2022, 11(3): 592-601.
6. Clavier JB, Antoni D, Atlani D, et al. Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer. Dis Esophagus, 2014, 27(6): 560-567.
7. Quyen TC, Angkatavanich J, Thuan TV, et al. Nutrition assessment and its relationship with performance and Glasgow prognostic scores in Vietnamese patients with esophageal cancer. Asia Pac J Clin Nutr, 2017, 26(1): 49-58.
8. 徐秀娟, 杨帆, 蒋淑年, 等. 营养风险对老年早期食管癌患者放疗的预后的影响. 肿瘤学杂志, 2018, 24(9): 866-870.
9. Gellrich NC, Handschel J, Holtmann H, et al. Oral cancer malnutrition impacts weight and quality of life. Nutrients, 2015, 7(4): 2145-2160.
10. Pressoir M, Desné S, Berchery D, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer, 2010, 102(6): 966-971.
11. Fukuda Y, Yamamoto K, Hirao M, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol, 2015, 22 Suppl 3: S778-S785.
12. Álvaro Sanz E, Garrido Siles M, Rey Fernández L, et al. Nutritional risk and malnutrition rates at diagnosis of cancer in patients treated in outpatient settings: Early intervention protocol. Nutrition, 2019, 57: 148-153.
13. Zhang L, Lu Y, Fang Y. Nutritional status and related factors of patients with advanced gastrointestinal cancer. Br J Nutr, 2014, 111(7): 1239-1244.
14. Fujisawa K, Ohkura Y, Ueno M, et al. Nutritional outcomes of thoracic duct resection for radical esophagectomy by assessing body composition changes in one year: A single-center retrospective study. Ann Surg Oncol, 2021, 28(13): 8414-8425.
15. 王艳莉, 辛晓伟, 周秀耕, 等. 食管癌手术病人相位角与营养状况的相关性研究. 肠外与肠内营养, 2019, 26(2): 65-69.
16. Movahed S, Varshoee Tabrizi F, Pahlavani N, et al. Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: A cross-sectional study. Clin Nutr, 2021, 40(6): 4449-4455.
17. Kubo Y, Miyata H, Sugimura K, et al. Prognostic implication of postoperative weight loss after esophagectomy for esophageal squamous cell cancer. Ann Surg Oncol, 2021, 28(1): 184-193.
18. Ericson J, Lundell L, Lindblad M, et al. Assessment of energy intake and total energy expenditure in a series of patients who have undergone oesophagectomy following neoadjuvant treatment. Clin Nutr ESPEN, 2020, 37: 121-128.
19. Ludwig DJ, Thirlby RC, Low DE. A prospective evaluation of dietary status and symptoms after near-total esophagectomy without gastric emptying procedure. Am J Surg, 2001, 181(5): 454-458.
20. Okabe H, Tsunoda S, Sunagawa H, et al. A long-term follow-up study of minimally invasive Ivor Lewis esophagectomy with linear stapled anastomosis. Surg Endosc, 2022, 36(3): 1979-1988.
21. Miyazaki T, Tanaka N, Hirai H, et al. Ghrelin level and body weight loss after esophagectomy for esophageal cancer. J Surg Res, 2012, 176(1): 74-78.
22. Murphy CF, Fanning M, Raftery N, et al. Early experience with a nutrition and survivorship clinic in esophageal cancer. Dis Esophagus, 2021, 34(2): doaa061.
23. 雷海科, 廖忠莉, 李小升, 等. 重庆市食管癌患者生存随访调查及预后影响因素研究. 中国癌症杂志, 2020, 30(2): 98-105.
24. Finley FJ, Lamy A, Clifton J, et al. Gastrointestinal function following esophagectomy for malignancy. Am J Surg, 1995, 169(5): 471-475.
25. McLarty AJ, Deschamps C, Trastek VF, et al. Esophageal resection for cancer of the esophagus: Long-term function and quality of life. Ann Thorac Surg, 1997, 63(6): 1568-1572.
26. Cao J, Xu H, Li W, et al. Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer. Curr Probl Cancer, 2021, 45(1): 100638.
27. Martin L, Jia C, Rouvelas I, et al. Risk factors for malnutrition after oesophageal and cardia cancer surgery. Br J Surg, 2008, 95(11): 1362-1368.
28. Shim H, Cheong JH, Lee KY, et al. Perioperative nutritional status changes in gastrointestinal cancer patients. Yonsei Med J, 2013, 54(6): 1370-1376.
29. 张芳. 贫血、吸烟、饮酒、体重指数与食管鳞癌预后关系的临床研究. 山东大学, 2014.
30. He Y, Liang D, Du L, et al. Clinical characteristics and survival of 5283 esophageal cancer patients: A multicenter study from eighteen hospitals across six regions in China. Cancer Commun (Lond), 2020, 40(10): 531-544.
31. 刘阳阳. 循环肿瘤细胞、中性粒细胞淋巴细胞比值及体重指数对局部晚期食管鳞癌患者预后评估中的临床价值. 吉林医学, 2022, 43(3): 796-799.
32. 罗越魁, 王成, 孟于琪, 等. 体重指数与食管鳞状细胞癌切除术后转归及总生存率关系的研究. 中国胸心血管外科临床杂志, 2016, 23(5): 467-471.
33. Garcidueñas-Fimbres TE, Paz-Graniel I, Nishi SK, et al. Eating speed, eating frequency, and their relationships with diet quality, adiposity, and metabolic syndrome, or its components. Nutrients, 2021, 13(5): 1687.Garcidueñas-Fimbres TE, Paz-Graniel I, Nishi SK, et al. Eating speed, eating frequency, and their relationships with diet quality, adiposity, and metabolic syndrome, or its components. Nutrients, 2021, 13(5): 1687.
34. Zhu Y, Hollis JH. Associations between eating frequency and energy intake, energy density, diet quality and body weight status in adults from the USA. Br J Nutr, 2016, 115(12): 2138-2144.Zhu Y, Hollis JH. Associations between eating frequency and energy intake, energy density, diet quality and body weight status in adults from the USA. Br J Nutr, 2016, 115(12): 2138-2144.
35. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN guidelines on enteral nutrition: Terminology, definitions and general topics. Clin Nutr, 2006, 25(2): 180-186.
36. Parsons EL, Stratton RJ, Cawood AL, et al. Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents. Clin Nutr, 2017, 36(1): 134-142.
37. 石海燕, 陈宏林, 吴超, 等. 口服营养补充对食管癌根治术后出院患者营养状况影响的研究. 中国现代医生, 2021, 59(11): 176-179.
38. 吴启润, 罗婷, 王鹏. 营养支持方式在肿瘤晚期患者中应用现状及展望. 实用肿瘤学杂志, 2018, 32(4): 381-384.
39. 贾震易. 家居肿瘤患者的口服营养补充. 肿瘤代谢与营养电子杂志, 2015(1): 19-22.
40. 杜小萍, 吕冬宁. 低磷饮食干预对肾衰竭血液透析病人营养状况、心理状况、血磷、血糖管理的影响. 护理研究, 2016, 30(29): 3636-3639.
41. Yang L, Gao J, Zhou Y, et al. Effect of oral nutritional supplements on patients with esophageal cancer during radiotherapy. Cancer Biother Radiopharm, 2023, 38(2): 89-94.
42. Xie H, Chen X, Xu L, et al. A randomized controlled trial of oral nutritional supplementation versus standard diet following McKeown minimally invasive esophagectomy in patients with esophageal malignancy: A pilot study. Ann Transl Med, 2021, 9(22): 1674.
43. Baldwin C, Spiro A, Ahern R, et al. Oral nutritional interventions in malnourished patients with cancer: A systematic review and meta-analysis. J Natl Cancer Inst, 2012, 104(5): 371-385.
44. 杨雪蓝, 吴沛霞, 席淑新, 等. 头颈癌病人围术期去脂体重丢失情况及影响因素分析. 护理研究, 2020, 34(24): 4356-4361.
45. 王家成, 孙琳, 张献娜, 等. GLIM标准下胃肠道恶性肿瘤手术患者营养状况调查及发生营养不良的影响因素分析. 现代肿瘤医学, 2023, 31(17): 3216-3221.
46. 高文华. 鼻咽癌放疗术后吞咽障碍患者营养风险指数状况及其相关因素分析. 中国医学文摘(耳鼻咽喉科学), 2023, 38(5): 12-16.
47. 徐国英, 魏娟青. 肺癌患者放疗期间发生营养不良的危险因素分析及护理. 全科医学临床与教育, 2022, 20(5): 477-478.
48. 周欣, 程敏琼, 黄晓萍, 等. 恶性肿瘤患者放疗期间营养不良发生及危险因素分析. 国际老年医学杂志, 2021, 42(4): 203-207, 234.
49. Grace EM, Shaw C, Lalji A, et al. Nutritional status, the development and persistence of malnutrition and dietary intake in oesophago-gastric cancer: A longitudinal cohort study. J Hum Nutr Diet, 2018, 31(6): 785-792.
50. Martin L, Findlay M, Bauer JD, et al. A multi-site, international audit of malnutrition risk and energy and protein intakes in patients undergoing treatment for head neck and esophageal cancer: Results from INFORM. Nutrients, 2022, 14(24): 5272.
51. Lidoriki I, Schizas D, Mylonas KS, et al. Postoperative changes in nutritional and functional status of gastroesophageal cancer patients. J Am Nutr Assoc, 2022, 41(3): 301-309.

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Latest ArticlesCharacteristics and influencing factors of postoperative weight change in patients with esophageal cancer: A prospective longitudinal study

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