Nutrition Considerations in Esophagectomy Patients

Abstract

The primary indication for an esophagectomy is esophageal cancer or Barrett's esophagus with high-grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy is a major surgery involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to allow healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach). Placement of a feeding jejunostomy preoperatively or at time of surgery provides enteral access for patients who will experience eating challenges and a slow transition back to a normal diet, challenges that often lead to weight loss in the postoperative period. Supplemental tube feeding given nocturnally can provide a consistent intake while appetite, swallowing, and diet advancements improve during the convalescent period. The postesophagectomy diet advances from liquids to soft solids with restrictions to reduce discomfort and aid swallowing and digestion. The esophagectomy patient will experience physical, dietary, and social adaptation for several months postoperatively. Attention to nutrition throughout the process of diagnosis, treatment, and postoperative care is essential for optimal care of the esophagectomy patient.

Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy

“…10 Nasogastric tubes, gastrostomy (PEG) tubes, gastrojejunostomy (PEG-jejunostomy [PEG-J] tubes, and direct jejunostomy tubes are all effective options for delivering both hydration and nutrition, but none allow oral feeding. [11][12][13][14] Although some investigators have stated that PEG or PEG-J tubes are safe in these patients, this is a controversial issue, with some concerns regarding whether or not a prior PEG or PEG-J leads to worse operative outcomes. 15 The Polyflex stent is a self-expanding plastic stent and is established to be useful in a variety of esophageal diseases, both benign and malignant.…”

Early Postoperative 24-Hour Continuous Jejunostomy Feeding in Esophagectomy Patients

“…In cases where preoperative radiotherapy and chemotherapy are administered during esophageal cancer treatment, preoperative dysphagia and weight loss are commonly observed. Since oral diet cannot be initiated for at least 1 week after esophagectomy, the malnutrition can be aggravated by insufficient nutritional support [1]. Early enteral feeding has been advocated in esophagectomy patients as it could reduce postoperative morbidity.…”

Management of esophageal adenocarcinoma

“…Preoperative conditioning, especially nutritional management, ceasing smoking and respiratory therapy are important factors. Pre and postoperative nutritional support associated with immunonutrition (Oral Impact ® ) is essential to decrease the postoperative complication rate [18,38,39].…”