Micronutrient insufficiency after surgery for oesophagogastric neoplasms: A prospective intervention study VITAMin Insufficiency in oesophagogastric Neoplasms or the VITAMIN study

Oesophageal and gastric cancer are among the top ten cancers worldwide. Both diseases have major impact on the nutritional status and quality of life (QoL). Preoperative malnutrition is reported in 42-80%. However, studies investigating postoperative nutritional status are scarce and postoperative identification and treatment of micro- and macro-nutritional deficiencies are currently lacking in (inter-)national guidelines. The aim of this study is to identify and target micronutrient deficiencies after surgery for oesophageal or gastric neoplasms.

This is a single centre prospective intervention trial with inclusion of 248 patients who underwent oesophagectomy (n=124) or (sub)total gastrectomy (n=124). Patients will receive a tailormade multivitamin supplement which differs per group and additionally a calcium supplement. Baseline measurements consist of blood withdrawal, faecal elastase-1 analysis, QoL and dietary behaviour. After 6, 12 and 24 months from baseline, measurements are repeated, and a supplement questionnaire is added. The primary objective is micronutrient deficiency (yes/no). Secondary objectives include occurrence and symptoms of pancreas insufficiency (n,%), time between surgery and start of supplementation (mean in months) and QoL at all time points.

Inclusion started in December 2021 and is still recruiting. Currently, baseline results of 61 included patients are available (oesophagectomy; n=36, gastrectomy; n=21). 80.6% had at least one micronutrient deficiency and 62.1% had at least two. The found deficiencies in this population were vitamin D (52.4%), iron (31.1%), ferritin (31.1%), zinc (24.6%), calcium (13.1%), folic acid (11.5%), vitamin B (4.9%), vitamin B12 (4.9%), vitamin B1 (3.3%) (table 1). Decreased faecal elastase-1 ( < 200 mg/kg) was found in 24.1% of the total population. Quality of life was reported to be 82.8%. Measurements performed six months after baseline have been analysed for 41 patients. At baseline, 85.4% had minimal one deficiency. After six months this number was reduced to 29.3%. The deficiencies still found in this population after six months of supplementation were iron (17.1%), zinc (14.6%), calcium (4.8%), magnesium (4.8%), and vitamin A (2.1%).

Literature regarding the incidence of micronutrient deficiencies and supplementation after oesophageal and gastric surgery is scarce. Preliminary results of this study show that most patients who underwent esophagogastric surgery have deficiencies and that vitamin supplementation may reduce these deficiencies. If micronutrient deficiencies are significantly present in this population and daily supplementation can prevent and resolve these deficiencies, routine monitoring and supplementation of micronutrient deficiencies can be implemented in the standard postoperative care of oesophageal and gastric surgery.

NCT05281380.

The authors.

Has not received any funding.

A. van der Velden: Research grant / Funding (self): GIKAVI. All other authors have declared no conflicts of interest.