Goal-directed nutritional support in preserving muscle mass and optimising recovery in treatment of oesophageal cancer: results of a prospective non-randomised cluster trial

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Abstract Purpose Oesophageal cancer (OEC) treated with neoadjuvant chemoradiotherapy (CRT) followed by oesophagectomy is associated with muscle loss and impaired recovery. We aim to evaluate whether a goal-directed nutritional support protocol (GDNS) is associated with muscle loss and improved survival after CRT and oesophagectomy compared with usual care. Methods Adults with OEC undergoing CRT and oesophagectomy were included. In this trial, a tertiary centre provided GDNS, and a secondary hospital offered usual care. Changes in appendicular skeletal muscle index (ASMI) were assessed during CRT and up to 12 months postoperatively using bioelectrical impedance analysis. One-year overall and disease-free survival were investigated. Results GDNS and usual care each included 50 patients. Between baseline and CRT completion, ASMI declined in GDNS (-2.53 ± 3.43%) and usual care (-3.20 ± 6.92%, P = 0.559), recovered between CRT completion and preoperatively (0.95 ± 4.33 vs 2.51 ± 7.95%; P = 0.368; respectively), and declined 12-months postoperatively (-5.75 ± 4.75% vs -7.09 ± 7.38%; P = 0.598; respectively). Results remained non- significant after adjustment for confounders and time × group interaction. Survival did not differ between groups. Conclusion In both GDNS and usual care, ASMI declines during CRT, recovers after, and decreases postoperatively. The magnitude of ASMI loss is smaller with GDNS than with usual care, although not statistically significant. Survival does not differ between groups. Our findings underscore the need for personalised, integrated interventions to optimise recovery, particularly in the postoperative phase.