Abstract
Background: Patients undergoing surgery for esophageal cancer are at risk of prolonged hospital stay for postoperative malnutrition. Postoperative early oral feeing is a part of the “enhanced recovery after surgery protocol” for coping with this risk. However, the usefulness of early oral intake during perioperatively is questionable. Methods: In total, 117 patients treated surgically for esophageal cancer were analyzed in the study. We assessed the oral energy sufficiency rate per nutritional requirement (oral-E/NR) at the fourth week postoperatively and classified the patients into two groups: Poor oral intake group (POI group; <25% oral-E/NR) and the control group (≥25% oral-E/NR). We analyzed the relationship among postoperative oral intake and prognoses. Results: The POI group had worse postoperative nutritional status and a lower survival rate than the control group. In a multivariate analysis, <25% oral-E/NR was one of the independent factors contributing to negative outcomes postoperatively (adjusted hazard ratio: 2.70, 95% confidence interval: 1.30–5.61). Conclusions: In patients undergoing surgery for esophageal cancer, poor postoperative oral intake negatively affected not only on their postoperative nutritional status but also their overall prognosis. It is necessary to improve the adequacy of oral intake postoperatively for patients with esophageal cancer.
Highlights
Esophagectomy is one of the most invasive surgeries performed in patients with esophageal cancer; in addition to tumor resection, this surgery requires a wide operative field with lymph node dissection and resection
As we had been in the process of shifting the major nutritional management from total parenteral nutrition (TPN) to gut (EN and oral), we secured TPN and EN routes in almost all patients at our hospital, and nutrition management was primarily based on EN
We primarily based on the EN route suggested that the POI group demonstrated poor prognosis revealed that assessing the oral intake at the fourth week postoperatively in patients treated surgically compared to the control group that could manage oral feeding
Summary
Esophagectomy is one of the most invasive surgeries performed in patients with esophageal cancer; in addition to tumor resection, this surgery requires a wide operative field with lymph node dissection and resection. Some patients treated surgically for esophageal cancer require supplemental nutritional management using enteral and parenteral nutrition to fulfill their nutritional requirements (NRs) during perioperatively. The most general algorithms for nutrition administration have recommended that oral intake, the physiological food administration route, be re-established as soon as possible and that it should take priority over EN and PN [10,11]. Based on these guidelines, studies on nutrition administration in critically ill patients have questioned the nutrition quantity and timing of administration using EN and PN [12,13,14,15]. In a multivariate analysis,
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