Comparative Analysis of Enteral and Parenteral Nutrition Impact on Outcomes in Esophageal Cancer Patients: A Paradigm for Nutritional Optimization in Oncology

Abstract

Background: Individuals diagnosed with esophageal cancer face a pronounced risk of malnutrition, primarily attributed to the early onset of gastrointestinal obstruction. This risk persists and may even intensify following therapeutic interventions and the subsequent reconstruction of gastrointestinal passages. The current study focuses on elucidating the differential impact of enteral vs. parenteral nutrition on outcomes in patients hospitalized with esophageal cancer. Methods: The study analyzed adult discharges related to esophageal cancer from 2019 and 2020 using data from the National Inpatient Sample. Exclusion criteria included discharges involving minors and mixed nutritional regimens. Enteral nutrition and parenteral nutrition subgroups were identified using International Classification of Diseases, 10th revision codes. Outcome variables were determined through ICD-10 codes in the NIS dataset. Multivariable regression analyses were used to investigate associations between mode of nutrition and specified outcomes. Results: In this study involving 28,015 hospitalizations for esophageal cancer, 756(2.7%) received enteral nutrition, and 1064(3.8%) received parenteral nutrition. After adjusting for confounding variables, parenteral nutrition emerged as an independent predictor of mortality (OR 1.75, P=0.023), while enteral nutrition showed no association with higher mortality (OR 0.56, P=0.162). Both nutrition modes were associated with increased length of stay, with patients on parenteral nutrition having significantly longer stays (+9.07 days, P<0.001 vs 3.07 days, P=0.001). While both nutrition modes were linked to high total hospitalization charges, patients with parenteral nutrition experienced a significantly more significant increase in total treatment cost compared to those on enteral nutrition (112,093 USD, P<0.001 vs 54,953 USD, P=0.01) patients on enteral nutrition had lower odds of pneumonia compared to the parenteral nutrition group. The parenteral nutrition group had higher odds of various complications, including esophageal perforation, constipation, diarrhea, acute kidney injury, ICU admission, and acute respiratory failure, than those on enteral nutrition. Both forms of nutrition were associated with increased odds of malnutrition, fluid and electrolyte disorders, and septic shock. Conclusion: Parenteral nutrition has a higher risk of mortality compared to enteral nutrition. Both types are linked to longer hospital stays, increased treatment costs, and other adverse outcomes, with parenteral nutrition leading to more complications than enteral nutrition.