Effects of preoperative nutrition on postoperative outcomes in esophageal cancer: a systematic review and meta-analysis

Abstract

Summary Postoperative enteral nutrition has been widely implemented in esophageal cancer, but the efficacy and safety of preoperative nutrition, particularly immune-enhancing nutrition (IEN), remain controversial. This meta-analysis aims to provide a quantitative synthesis of whether preoperative nutrition improves postoperative morbidity and mortality in patients with resectable esophageal cancer. A systematic search was conducted in Medline, Embase, Cochrane, and databases of clinical trials dated up to December 2019. Randomized controlled trials and observational studies comparing postoperative outcomes between esophageal cancer patients with and without preoperative nutritional support were included. Random-effects model was applied in the meta-analysis of primary outcomes (overall complication rate, in-hospital mortality) and secondary outcomes (infectious complication rate, anastomotic leak rate, length of postoperative hospital stay). Complications of feeding tube access and perioperative weight loss were evaluated by qualitative synthesis. Subgroup analyses were performed by stratifying immunonutrition and standard nutrition before surgery. Subgroup analysis of randomized controlled trials alone was also done. A total of 15 studies enrolling 1864 participants were included. The overall meta-analysis found that preoperative nutrition could reduce infectious complications (odds ratio [OR] = 0.51, 95% confidence interval [CI] [0.26, 0.98]; I2 = 48%) and length of hospital stay (mean difference = −2.10 day, 95% CI [−3.72, −0.47]; I2 = 78%) after esophagectomy, whereas no significant difference was revealed in the incidence of overall complications (OR = 0.76, 95% CI [0.52, 1.11]; I2 = 32%), in-hospital mortality (OR = 1.03, 95% CI [0.41, 2.61]; I2 = 12%), and anastomotic leak (OR = 1.05, 95% CI [0.69, 1.58]; I2 = 0%). Subgroup of preoperative immunonutrition showed more prominent benefits. The complication rate of feeding tube access was low (1.6–16%). In conclusion, preoperative nutrition is safe in esophageal cancer, but benefits are observed in infectious complication rate and length of stay on a limited scale. IEN holds more advantages over standard nutrition. Randomized trials in the context of nutritional support during neoadjuvant therapy are in demand.

The influence of Nutren on postoperative nutritional status, inflammation and incision healing in patients with colon cancer

“…The Gln and arginine are able to boost the body's protein synthesis and nitrogen balance, maintain the integrity of the intestinal mucosa, and prevent bacterial translocation. Additionally, no distinct differences are in the survival rate, recurrence rate, and distant metastasis rate between the two after surgery of 2 years, manifesting that ENT for CC patients after surgery does not impact the prognosis (Xueting et al, 2021;Cao et al, 2021). It is primarily associated with few patients covered in this study, so the sample size should be elevated to further analyze the impact of the treatment on the prognosis of patients.…”

Update enterale und parenterale Ernährung

“…Aktuell ist für Patienten mit Ösophagusresektion im Vergleich zu einer enteralen Standardernährung eine signifikante Verbesserung der Immunparameter CD4/ CD8-Quotient, Anteil an Killerzellen (NK) und der Ig-A-Serumspiegel, jedoch ohne Einfluss auf das klinische Ergebnis, gezeigt worden [21]. Cao et al fanden im Vergleich mit der Standardnahrung auch im klinischen Outcome Vorteile für die Immunmodulation [4]. Mit den zahlreichen randomisierten klinischen Studien und deren Metaanalysen sind klinische Vorteile für die Senkung der Rate infektiöser Komplikationen, der Krankenhausverweildauer und auch der Kosten gezeigt worden [20].…”

“…Dieses klinisch häufig nicht apparente "metabolische Risiko" kann leicht unterschätzt werden und ist deswegen auch als "stille Epidemie" bezeichnet worden [2]. Der prognostische Einfluss der Mangelernährung/Sarkopenie auf postoperative Komplikationen und die Krankenhausaufenthaltsdauer ist lange bekannt und aktuell wieder gezeigt worden [3,4,5].…”

Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery

“…The prognostic influence of the nutritional status on the occurrence of postoperative complications and the length of hospital stay has been shown many times retrospectively and prospectively [6][7][8], resulting in evidence-based guidelines on nutritional therapy for the surgical patient: European Society for Clinical Nutrition and Metabolism (ESPEN) 2017 [7] and Short ESPEN Practice guideline 2021 [9]. The ESPEN surgical guidelines are in line with the aim of early oral feeding in ERAS [7]:…”

“…-Integration of nutrition and nutritional status in the overall management -Avoiding prolonged periods of sobriety preoperatively -Start nutritional therapy as soon as metabolic risk is apparent -Metabolic monitoring of blood sugar levels -Reduction of factors that trigger stress and catabolism or impair gastrointestinal motility and function -Early mobilization to stimulate protein synthesis and to maintain muscle function It is evident that in most patients, oral/enteral feeding can be started just a few hours after abdominal surgery. This also applies to anastomoses in the upper gastrointestinal tract [6,7]. Oral food intake as early as possible is a key intervention of the ERAS program [10].…”