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Rationale: Animal models have showed that ubiquitinproteasome pathway (UPP) may be the effector of muscle loss during cancer cachexia. However, evidence from clinical studies is still needed to understand mechanisms involved in cancer induced muscle catabolism in patients. Methods: Patients (n = 17, 64±6 years) diagnosed with esophageal cancer were undergoing surgery with intent of resection of the primary tumor. As a control group, weight stable patients undergoing reflux surgery (n = 10, 60±7 years) were included. Vastus lateralis muscle biopsies were taken with a Bergstrom needle. Diaphragm biopsies were obtained by open surgery (cancer group) and by laparoscopic surgery (control group). Proteasome, caspase 3, calpains and lysosomal enzymatic activities were measured by using specific fluorogenic peptide substrates. Differences between the groups were tested with a Student’s t-test. Results: Cathepsin L activity was 115% higher in the vastus lateralis of cancer patients compared to the controls (5.3±0.4 vs 2.5±0.3 pmol/min/mg; p < 0.001). Cathepsin B activity in vastus lateralis was 85% higher in the cancer group compared to the control group (2.4±0.2 vs 1.3±0.2 pmol/min/mg; p < 0.001). This latter activity was correlated to the self-reported body weight loss of cancer patients (R2 = 0.41, p = 0.03). In diaphragm, activities of both cathepsins were 60% higher in cancer patients compared to the controls (p < 0.01). Proteasome, calpain and caspase3 activities did not differ between the two groups neither in vastus lateralis nor in diaphragm. Conclusion: The finding of weight-loss related activation of cathepsins in both skeletal and respiratory muscles in patients with esophageal cancer suggest that the lysosomal pathway might be involved in the development of cancer cachexia. In contrast to animal studies, in our study, UPP seems not to be the main or exclusive system implicated in muscle loss during cachexia.

Rationale: Perioperative nutritional support via a surgically placed jejunostomy is commonly used in patients undergoing surgical resection of oesophago-gastric cancer. With the development of laparoscopic resectional techniques, is the use of jejunal feeding as safe as at open surgery? Methods: A prospective, comparative study of patients undergoing 2-stage oesophagectomy prior to and following the instigation of laparoscopic gastric mobilization and jejunostomy formation. End points assessed included major surgical complications, mechanical displacement and dislodgement and days of successful feeding. Results: 50 patients were assessed, 25 before and 25 after the change of practice (M:F ratio was 8:2, median age: 64 years). All had a successful insertion of jejunostomy and none had a significant surgical complication at time of insertion. Mechanical complications were similar between the 2 groups (8% in open surgery vs 12% in laparoscopic surgery) The mean number of days of nutritional support was also similar between the two sets of patients (medians with interquartile range) 39.6±42.35 days for open surgery and 19.6±13.21 days for laparoscopic insertion. Conclusion: Laparoscopically placed jejunostomies are as reliable and safe as those placed at open surgery for peri-operative nutritional support in patients undergoing oesophago-gastric cancer resection.

age 63.1±17.9 years, height 1.69±0.09m, weight 73.6±25.6 kg, BMI 25.5±8 kg/m2, NRS-Total 2.86±1.41 pts, energy needs (BEE+20% activity) 1762±464 kcal. Regarding age, 41% (n = 893) of patients were 70 y old. The risk of having ME were insignificant for every decade group, but for the 81 90 years old, the odds were 1.45 (95%CI: 1.14 1.84). Especially patients with cancer had a significant higher score of having MN than patients without (NRS 3.4±1.4 vs. 2.7±1.4 p < 0.001). The risk group was significantly older (63.8±17.9 vs. 61.8±17.8 y, p = 0.01), had a significant lower BMI (24±5.9 vs. 27.3±9.2 kg/m2, p < 0.001) and significantly lower energy needs (1681±316 kcal vs. 1855±557, p < 0.001). Loss of appetite during the past 7 days and pathological weight loss were the most common reasons for more points in the NRS. Only 8% (n = 94) had a high NRS due to isolated low BMI (