Immediate Postoperative Oral Nutrition Following Esophagectomy: A Multicenter Clinical Trial

Weijs, Teus J.; Berkelmans, Gijs H K; Nieuwenhuijzen, Grard A. P.; Dolmans, Annemarie C.P.; Kouwenhoven, Ewout A.; Rosman, Camiel; Ruurda, Jelle P.; Workum, Frans van; Det, Marc J. van; Corten, Luis Carlos Silva; Hillegersberg, Richard van; Luyer, Misha

doi:10.1016/j.athoracsur.2016.04.067

Cited by 83 publications

(72 citation statements)

References 38 publications

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“…As such, they reflect neither the typical Western esophageal cancer patient nor the cohort studied by Weijs et al (14). Their current study differs from other prior investigations in that the majority of their patients had locally advanced esophageal adenocarcinoma and underwent neoadjuvant chemoradiotherapy instead of proceeding directly to resection.…”

Section: Editorialcontrasting

confidence: 46%

The ongoing debate regarding optimal nutritional routes following esophagectomy

Knight

Blackmon

2016

J. Thorac. Dis.

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Section: Editorialcontrasting

confidence: 46%

The ongoing debate regarding optimal nutritional routes following esophagectomy

Knight

Blackmon

2016

J. Thorac. Dis.

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“…On the contrary, the only two nonrandomized studies investigating early oral feeding following esophagectomy concluded that early oral feeding is feasible, safe, and does not increase complications [85,86], and is associated with a reduced length of hospital stay [85], compared to a nil-bymouth regime and tube feeding during the first week. A randomized controlled trial on the safety and feasibility of early oral feeding is ongoing [87].…”

Section: Initiation Of Nutritionmentioning

confidence: 99%

Nutrition in peri-operative esophageal cancer management

Steenhagen

Vulpen

Hillegersberg

et al. 2017

Expert Review of Gastroenterology & Hepatology

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Introduction: Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, perioperative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to longterm nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.ARTICLE HISTORY

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“…However, following esophagectomy early initiation of oral intake is believed to increase sequelae of anastomotic leakage and pneumonia rates. Though a safety and feasibility trial has shown encouraging results the results of a randomized controlled trial on this topic have to be awaited (28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Routine jejunostomy tube feeding following esophagectomy

Weijs¹,

Eden²,

Ruurda³

et al. 2017

J. Thorac. Dis.

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Background: Malnutrition is an important problem following esophagectomy. A surgically placed jejunostomy secures an enteral feeding route, facilitating discharge with home-tube feeding and long-term nutritional support. However, specific complications occur, and data are lacking that support its use over other enteral feeding routes. Therefore routine jejunostomy tube feeding and discharge with home-tube feeding was evaluated, with emphasis on weight loss, length of stay and re-admissions.Methods: Consecutive patients undergoing esophagectomy for cancer, with gastric tube reconstruction and jejunostomy creation, were analyzed. Two different regimens were compared. Before January 07, 2011 patients were discharged when oral intake was sufficient, without tube feeding. After that discharge with home-tube feeding was routinely performed. Logistic regression analysis corrected for confounders.Results: Some 236 patients were included. The median duration of tube feeding was 35 days. Reoperation for a jejunostomy-related complication was needed in 2%. The median body mass index (BMI) remained stable during tube feeding. The BMI decreased significantly after stopping tube feeding: from 25.6 (1st-3rd 3.9% (1.5-6.3%)]. Weight loss was not affected by the duration of tube feeding duration. Routine home-tube feeding did not affect weight loss, admission time or the readmission rate.Conclusions: Weight loss following esophagectomy occurs once that tube feeding is stopped, independently from the time interval after esophagectomy. Moreover routine discharge with hometube feeding does not reduce length of stay or readmissions. These findings question the value of routine jejunostomy placement and emphasize the need for further research.

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Immediate Postoperative Oral Nutrition Following Esophagectomy: A Multicenter Clinical Trial

Cited by 83 publications

References 38 publications

The ongoing debate regarding optimal nutritional routes following esophagectomy

The ongoing debate regarding optimal nutritional routes following esophagectomy

Nutrition in peri-operative esophageal cancer management

Routine jejunostomy tube feeding following esophagectomy

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