Beneficial Effects of Immediate Enteral Nutrition After Esophageal Cancer Surgery

Abstract

This study was conducted to determine the effects of immediate enteral nutrition (EN) on nutritional status, immunological competence, and the suppression of excessive inflammatory responses in patients following esophageal cancer surgery. Twenty-four patients who underwent the same elective operation for thoracic esophageal carcinoma were randomized into an immediate enteral nutrition (IEN) group who received EN from postoperative day (POD) 1 and a parenteral nutrition (PAN) group. Both groups received comparable volumes and calories on the same POD. Laboratory studies were carried out preoperatively and on PODs 1-7. Other nutritional and immunological assessments were repeated on PODs 1 and 7. Plasma concentrations of nitrate and nitrite were also measured. All of the patients in the IEN group tolerated enteral feeding well. There were no significant differences in the results of nutritional assessments, lymphocyte function, or plasma nitrate and nitrite levels between the two groups. The IEN group showed a significantly earlier recovery of the total lymphocyte count. The serum levels of total bilirubin and C-reactive protein were significantly attenuated in the IEN group. These results indicate that immediate EN may have beneficial effects on immunological competence and the suppression of excessive inflammatory responses in patients following esophagectomy. Patients undergoing radical esophageal surgery who are subjected to severe surgical stress might benefit the most from early EN.

Nutritional access routes following oesophagectomy—a systematic review

“…Performing a power calculation for their primary outcomes would help identify such potential errors but only one of the studies performed such a calculation (Cooper et al, 2006), suggesting that 40-60 patients and 100 patients per arm will be required to show a significant difference in mortality and 30 day complications, respectively. Shiraishi et al (2005) and Aiko et al (2001), attempt to examine the benefit of enteral feeding in patients undergoing oesophagectomy. As above, both studies carry a risk of bias with no reported randomisation technique on a small number of patients.…”

“…As above, both studies carry a risk of bias with no reported randomisation technique on a small number of patients. Aiko et al (2001) combine parenteral and enteral feeding and compare them to parenteral feeding alone. As it may be possible to attribute central line complications to the enteral feeding route in the combined group, it is difficult to assess the impact that enteral feeding has got.…”

“…Enteral and parenteral nutrition vs parenteral nutrition alone Aiko et al (2001) compare combined jejunostomy and central line feeding with central line feeding alone. Oral diet was introduced on the 5th postoperative day.…”

“…Several studies have suggested that following gastrointestinal surgery, enteral nutrition is superior to parenteral nutrition (PN), resulting in a reduced length of hospitalisation and serious postoperative complication rates (McCarter et al, 1996;Velez et al, 1997;Aiko et al, 2001;Gabor et al, 2005;Mazaki and Ebisawa, 2008). However, these benefits are not necessarily reproduced following oesophagectomy.…”

Early Enteral Nutrition Versus Parenteral Nutrition After Resection of Esophageal Cancer: a Retrospective Analysis

“…However, reports of the effects of postoperative early enteral nutrition (EEN) specifically in patients undergoing esophagectomy were limited [14,22,23]. Furthermore, most clinical studies did not compare enteral nutrition and total parenteral nutrition in a randomized fashion [14,22,24].…”