Risk of fractures increases 1 year after esophageal cancer surgery: study

A Korean research team has identified a correlation between esophageal cancer surgery and fracture risk.

On Thursday, the joint research team released the results of its analysis of fracture risk in patients who underwent esophageal cancer surgery, published in the European Journal of Surgical Oncology.

Korean researchers identified a correlation between esophageal cancer surgery and fracture risk. They are, from left, Professors Shin Dong-wook, Cho Jong-ho, Kim Seong-hye, and Han Kyung-do. (Courtesy of SMC)

Professors Shin Dong-wook and Kim Seong-hye of the Department of Family Medicine, Professor Cho Jong-ho of the Department of Thoracic and Esophageal Surgery at Samsung Medical Center (SMC), and Professor Han Kyung-do of the Department of Statistics and Actuarial Science at Soongsil University conducted the study.

The research team analyzed data from the National Health Insurance Service, matching 4,847 patients who underwent surgery for esophageal cancer between 2009 and 2022 with 14,541 individuals without a history of cancer, based on age and gender. Esophageal cancer patients were followed for an average of five years, while the control group without a history of cancer was followed for eight years.

The study found that esophageal cancer survivors had a 46 percent higher risk of fracture. The risk of spinal fracture was 66 percent higher, and the risk of hip fracture exceeded 68 percent.

This was attributed to a combination of factors, including chronic inflammation caused by cancer, decreased bone density after surgery, anemia, deteriorating nutritional status, and reduced physical activity.

The fracture risk varied over time following esophageal cancer surgery. Within one year post-surgery, having a cancer history was not significantly associated with fracture risk. However, after one year, the overall fracture risk increased to 61 percent. The risk of hip fractures rose to 81 percent. A distinct long-term pattern was observed, with the risk persisting even beyond five years.

The research team explained that this may be because physical activity decreased immediately after surgery, leading to fewer falls.

“This study is the first to demonstrate fracture risk in Korean esophageal cancer survivors based on treatment outcomes and time elapsed after surgery,” Professor Kim said. “Continuous management and proactive treatment are necessary to prevent fractures in esophageal cancer survivors.”

Professor Cho noted, “The fracture risk became distinctly apparent one year after esophageal cancer surgery,” adding, “Long-term health management remains crucial even after cancer treatment.”

Professor Shin remarked, “The cancer treatment paradigm must now shift beyond mere ‘survival’ to encompass ‘survival and quality of life.’” He added, “The findings from this study can serve as crucial data for establishing personalized fracture prevention and management policies in the future.”