Perioperative Nutritional Management of Esophageal Cancer Surgery

Abstract

Perioperative nutritional status is known to be associated with the incidence of postoperative complications as well as the oncologic prognosis after esophagectomy. Several nutritional indicators such as the Controlling Nutritional Status Score, the Geriatric Nutritional Risk Index, the Prognostic Nutritional Index, the Nutrition Risk Screening, and the Skeletal Muscle Index were investigated to affect the morbidity and/or prognosis after esophagectomy or other treatment modalities for esophageal cancer. Meanwhile, early enteral nutrition (EN) has been introduced to improve the nutritional status in the early postoperative period. The postoperative early EN could decrease the morbidity of severe complications and maintain patients at a better nutritional status compared to parenteral nutrition support in patients undergoing esophageal surgery. The early EN started within several hours after gastrointestinal surgery, termed “immediate EN,” was proven safe and feasible. A combination of preoperative feeding and postoperative immediate enteral feeding should be recommended to achieve continuous nutrition support with a minimum interruption of enteral feedings. Immunonutrition refers to the oral or enteral administration of a formula containing one or more added nutrients such as omega-3 fatty acids (FAs), nucleic acid, arginine, glutamine, or antioxidants. Although the anti-inflammatory effects of omega-3 FAs were demonstrated, there remains insufficient evidence to recommend the routine use of immunonutrition in patients undergoing esophageal cancer surgery. The perioperative management of esophageal cancer surgery evolved from only nutritional and transfusional support into a multidisciplinary team medicine approach and the application of an enhanced recovery after surgery (ERAS) program. According to the ERAS Society, the documented high levels of perioperative morbidity and mortality after esophagectomy accentuated the need for providing an ERAS program. Immediate start of oral nutrition following esophagectomy seems to be feasible and does not increase complications. However, the most appropriate timing for starting oral intake after esophagectomy remains controversial.