Abstract
Objective: To retrospectively investigate the comparative efficacy, safety and cost-benefits of three nutritional treatment schemes including short peptide jejunal nutrition (SPJN), whole protein jejunal nutrition (WPJN), and partial parenteral nutrition (PPN) in patients underwent esophagectomy for esophageal cancer in our hospital. This study was carried out in accordance with the conceptual framework of nutritional therapy in fast-track rehabilitation surgery.Methods: We retrospectively reviewed 305 patients who were assigned to receive esophagectomy for esophageal cancer. Eligible patients was naturally divided into SPJN group [n = 98 (32.1%)], WPJN group [n = 95 (31.1%)], and PPN group [n = 112 (36.7%)] according to the type of nutritional scheme which was actually prescribed to patients by the attendingphysician in clinical practice. The differences of the serum total protein (TP), albumin (ALB), pre-albumin (PA), hemoglobin (HGB), white blood cells (WBCs), red blood cells (RBCs) and neutrophils were compared among 3 nutritional schemes groups. We also investigated the relationship of the fluid intake, urine output, gastric juice drainage volume and thoracic drainage volume among 3 nutritional groups at 3 days after surgery. Moreover, the differences of cost-benefit indexes, complications, length of hospitalization and hospital expenditure were also compared.Results: The serum TP, ALB, and PA in the SPJN group were all higher than those in the WPJN and PPN groups (p < 0.05). The gastric juice volume of gastrointestinal decompression drainage and fluid volume of thoracic drainage in the SPJN group were all less than that in the WPJN group (p < 0.05). The overall hospital stay and post-operative hospital stay in the SPJN group were all shorter than that in WPJN group (p < 0.05). Moreover, the incidence of post-operative complications including anastomotic leakage, infection, and gastrointestinal reaction was remarkably lower in the SPJN group compared to the WPJN group (p < 0.05). Interesting, hospital expenditure in the PPN group was less than that in the SPJN and the WPJN groups (p < 0.001).Conclusion: Patients may obtain benefits in improving protein level after receiving SPJN scheme at the early stage after esophagectomy. Meanwhile, patients may obtain benefits in improving post-operative complications and hospital stay after receiving SPJN or PPN compared to WPJN protocol. However, the difference between SPJN and PPN requires further study because no difference was detected in terms of clinical outcomes including complications and the length of hospitalization although PPN may achieve a possible decrease of medical expenditure.
Highlights
Issued statistics suggested that the estimated new cases of esophageal cancer are appropriate 258,000, and the cases of death are appropriate 193,000, ranking sixth in morbidity and fourth in mortality in China
Nutritional groups according to the types of nutritional schemes which were prescribed to patients by the attending physician in our hospital: short peptide jejunal nutrition (SPJN) group, whole protein jejunal nutrition (WPJN) group, and partial parenteral nutrition (PPN) group according to the nutritional schemes at the early postoperative period
We investigated the comparative effects of three different nutritional schemes, i.e. SPJN, WPJN and PPN protocol, on the post-operative protein level and found that: [1] the post-operative total protein (TP), ALB and PA in the SPJN group were significantly higher than those in the PPN group (Figures 2A–C), suggesting an beneficial adjustment effect of early application of SPJN on the post-operative protein level compared to WPJN and PPN schemes; [2] the post-operative ALB in the PPN group was remarkably higher than that in the WPJN group (Figure 2B), indicating that the beneficial adjustment effect of PPN on the protein level compared to WPJN preparation
Summary
Issued statistics suggested that the estimated new cases of esophageal cancer are appropriate 258,000, and the cases of death are appropriate 193,000, ranking sixth in morbidity and fourth in mortality in China. According to the statistics released by the World Health Organization (WHO), morbidity and mortality of esophageal cancer in China is ranking in fifth from global perspective, and new cases and deaths in China account for about 55% of those in the world [2]. The 5-year survival rate of esophageal cancer patients in China is about 30%, which is lower than that in South Korea and Japan [3]. Esophagectomy is still the most common radical treatment for patients with esophageal cancer when patients experienced typical symptoms such as dysphagia and eating obstruction. Reasonable and standardized nutritional treatment after esophagectomy remains a critically important step for accelerating the rehabilitation of esophageal cancer patients underwent esophagectomy [3, 4]
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