Vitamin insufficiency after surgery for oesophagogastric neoplasms - a study protocol for a prospective intervention study

Sep 24, 2026

Oesophageal cancer and gastric cancer affect patients’ nutritional status and quality of life, and while preoperative malnutrition is common, evidence on postoperative micronutrient and macronutrient deficiencies remains limited. This single-centre prospective intervention trial aims to identify and target micronutrient deficiencies after surgery for oesophagogastric neoplasms. Two operation groups receive tailored multivitamin and calcium D3 supplementation with serial blood and faecal assessments, plus questionnaires over multiple follow-up time points.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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Abstract

Introduction

Methods

Ethics and dissemination

Strengths and limitations of this study

Background

Open access Protocol Vitamin insufficiency after surgery for oesophagogastric neoplasms: a study protocol for a prospective intervention study Ariadne L van der Velden ,1 Thomas A Vermeer,1 Evert-Jan G Boerma,1 Eric HJ Belgers,1 Jan HMB Stoot,1 Mathie PG Leers ,2 Meindert N Sosef,1 Guy HEJ Vijgen1 To cite: van der Velden AL, Vermeer TA, Boerma E-JG, et al. Vitamin insufficiency after surgery for oesophagogastric neoplasms: a study protocol for a prospective intervention study. BMJ Open 2023;13:e067981 . doi:10 . 1136/ bmjopen-2022-067981 ► Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online ([http://dx.doi.org/10.1136/](http://dx.doi.org/10.1136/)[ ](http://dx.doi.org/10.1136/)[bmjopen-2022-067981](bmjopen-2022-067981)) . Received 09 September 2022 Accepted 03 June 2023 © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 1Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands 2Clinical Chemistry & Hematology, Zuyderland Medical Centre, Heerlen, The Netherlands Correspondence to Dr Ariadne L van der Velden; [l.vandervelden@zuyderland.nl](l.vandervelden@zuyderland.nl) ABSTRACT Introduction Oesophageal cancer (EC) and gastric cancer (GC) are among the top 10 cancers worldwide. Both diseases impact the nutritional status of patients and their Quality of Life (QoL) . Preoperative malnutrition is reported in 42%–80% . However, studies investigating postoperative nutritional status are limited, and postoperative identification and treatment of micronutrient and macronutrient deficiencies are currently lacking in (inter-)national guidelines. The aim of this study is to identify and target micronutrient deficiencies after surgery for oesophagogastric neoplasms. Methods This is a single-centre prospective intervention trial performed in Zuyderland Medical Centre. 248 patients who underwent oesophagectomy (n=124) or (sub) total gastrectomy (n=124) from 2011 until 2022 will be included. Both groups will receive Calcium Soft Chew D3 and a multivitamin supplement (MVS) specifically developed according to the type of operation patients underwent; the oesophagectomy group will receive Multi-E and the gastrectomy group will receive Multi-G. The MVSs will be taken once daily and Calcium Soft Chew D3 two times per day. Supplementation will start after baseline measurements. At baseline (T0), blood withdrawal for micronutrient analysis and faecal elastase-1 analysis for exocrine pancreatic insufficiency (EPI) will be performed. Additionally, patients will receive questionnaires regarding QoL and dietary behaviour. After 180 days of supplementation (T1), baseline measurements will be repeated, and the supplement tolerance questionnaire will be completed. Measurements will also be conducted after 360 days (T2) and after 720 days (T3) of supplementation. The main study parameter is micronutrient deficiency (yes/ no) for all measurements. Secondary parameters include occurrence of EPI (n,%), diarrhoea (n,%), steatorrhoea (n,%) or bloating (n,%), time between surgery and start of supplementation (mean in months), and QoL at all time points. Ethics and dissemination The study was approved by the Zuyderland Medical Centre Ethics Committee, Heerlen, the Netherlands. The findings will be disseminated through scientific congresses and in peer-reviewed journals. Trial registration number NCT05281380. STRENGTHS AND LIMITATIONS OF THIS STUDY ⇒ This is the first study investigating micronutrient deficiencies in a large population of patients who underwent oesophagectomy or gastrectomy for oesophagogastric cancer. ⇒ Long follow-up to see whether a developed multivitamin supplement can resolve deficiencies. ⇒ A randomised controlled trial could not be performed due to large sample size calculation, which is not

FAQs

What is the primary goal of the prospective intervention study?

To identify and target micronutrient deficiencies after surgery for oesophagogastric neoplasms across scheduled follow-up measurements.

How many patients and what types of surgeries will be included?

A total of 248 patients will be included, with 124 undergoing oesophagectomy and 124 undergoing (sub)total gastrectomy between 2011 and 2022.

What supplementation and assessments are used in the trial?

Participants receive tailored multivitamin supplementation and Calcium Soft Chew D3, starting after baseline measurements, with blood micronutrient analysis and faecal elastase-1 testing for exocrine pancreatic insufficiency, plus QoL and dietary questionnaires over time.

Sep 24, 2026

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