Does Prolonged Enteral Feeding With Supplemental Omega-3 Fatty Acids Impact on Recovery Post-esophagectomy

Healy, Laura; Ryan, Aoife M.; Doyle, Suzanne; Bhuachalla, Éadaoin B. Ní; Cushen, S.; Segurado, Ricardo; Murphy, Thomas J.; Ravi, Narayanasamy; Donohoe, Claire L.; Reynolds, John V.

doi:10.1097/sla.0000000000002390

Cited by 43 publications

(68 citation statements)

References 44 publications

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“…Five RCTs have investigated the effectiveness of immunonutrition in patients before and/or after esophageal cancer surgery (59)(60)(61)(62)(63). The authors concluded no significant differences on clinical outcomes (e.g., overall complications, infectious complications, hospital stay, weight, QoL) between treatment and control group.…”

Section: Immunonutritionmentioning

confidence: 99%

Preoperative nutritional optimization of esophageal cancer patients

Steenhagen¹

2019

J. Thorac. Dis

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Optimization of the nutritional and metabolic state prior to major surgery leads to improved surgical outcomes and is increasingly seen as an important part of oncology disease management. For locally advanced esophageal cancer the treatment is multimodal, including neoadjuvant chemoradiotherapy or perioperative chemotherapy in combination with esophageal resection. Patients undergoing such a multimodal treatment have a higher risk for progressive decline in their nutritional status. Preoperative malnutrition and loss of skeletal muscle mass has been reported to correlate with unfavorable outcomes in patients who undergo esophageal cancer surgery. Decline in nutritional status is most likely caused by insufficient nutritional intake, reduced physical activity, systemic inflammation and the effects of anticancer therapy. To ensure an optimal nutritional status prior to surgery, it is key to assess the nutritional status in all preoperative esophageal cancer patients, preferable early in the treatment trajectory, and to apply nutritional interventions accordingly. Nutritional management of esophageal cancer can be challenging, the optimal nutritional therapy is still under debate, and warrants more nutritional scientific research. In this review, the most recent findings regarding preoperative nutrition associated with outcomes in patients with esophageal cancer will be explored.

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Section: Immunonutritionmentioning

confidence: 99%

Preoperative nutritional optimization of esophageal cancer patients

Steenhagen¹

2019

J. Thorac. Dis

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“…All patients were seen by respiratory physiotherapists on the day after operation and underwent personalized intensive respiratory physiotherapy until discharge. A 10‐Fr needle catheter jejunostomy was routinely placed at surgery, and feeding commenced on the first postoperative day. All patients underwent nutritional and physiotherapy assessment at a multidisciplinary clinic at diagnosis, before surgery and at serial postoperative time points, as described previously.…”

Section: Methodsmentioning

confidence: 99%

Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

Elliott

O’Byrne

Foley

et al. 2019

British Journal of Surgery

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Background It remains controversial whether neoadjuvant chemoradiation (nCRT) for oesophageal cancer influences operative morbidity, in particular pulmonary, and quality of life. This study combined clinical outcome data with systematic evaluation of pulmonary physiology to determine the impact of nCRT on pulmonary physiology and clinical outcomes in locally advanced oesophageal cancer. Methods Consecutive patients treated between 2010 and 2016 were included. Three‐dimensional conformal radiation was standard, with a lung dose–volume histogram of V20 less than 25 per cent, and total radiation between 40 and 41·4 Gy. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) were assessed at baseline and 1 month after nCRT. Radiation‐induced lung injury (grade 2 or greater), comprehensive complications index (CCI) and pulmonary complications were monitored prospectively. Health‐related quality of life was assessed among disease‐free patients in survivorship. Results Some 228 patients were studied. Comparing pulmonary physiology values before with those after nCRT, FEV1 decreased from mean(s.d.) 96·8(17·7) to 91·5(20·4) per cent (–3·6(10·6) per cent; P < 0·001), FVC from 104·9(15·6) to 98·1(19·8) per cent (–3·2(11·9) per cent; P = 0·005) and DLCO from 97·6(20·7) to 82·2(20·4) per cent (–14·8(14·0) per cent; P < 0·001). Five patients (2·2 per cent) developed radiation‐induced lung injury precluding surgical resection. Smoking (P = 0·005) and increased age (P < 0·001) independently predicted percentage change in DLCO. Carboplatin and paclitaxel with 41·4 Gy resulted in a greater DLCO decline than cisplatin and 5‐fluorouracil with 40 Gy (P = 0·001). On multivariable analysis, post‐treatment DLCO predicted CCI (P = 0·006), respiratory failure (P = 0·020) and reduced physical function in survivorship (P = 0·047). Conclusion These data indicate that modern nCRT alters pulmonary physiology, in particular diffusion capacity, which is linked to short‐ and longer‐term clinical consequences, highlighting a potentially modifiable index of risk.

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“…Twelve trials [17][18][19][20][21][22][23][24][25][26][27][28] that evaluated IN exclusively in esophageal cancer patients who underwent esophageal resection were published between January 1980 and August 2017 ( Table 1). The numbers of trials classified by evidence level are as follows: 1a, n = 0; 1b (RCT), n = 7; 2a, n = 5; 2b, n = 0; 3, n = 0; 4, n = 0.…”

Section: In In Patients Undergoing Esophagectomymentioning

confidence: 99%

“…Three RCTs [18,22,28] compared the perioperative administration of IN with a standard enteral diet. In the first, Sakurai et al [18] reported an RCT that compared IMPACT to a standard enteral diet (Ensure ® ; Abbott Japan).…”

Section: In In Patients Undergoing Esophagectomymentioning

confidence: 99%

“…However, no significant difference was seen in the length of SIRS or in the rates of SSI, pneumonia, anastomotic dehiscence, or in-hospital mortality. Recently, a multicenter double-blind RCT was reported by Healy et al [28] in the same group as in Ryan et al [22]. That trial focused not only on short-term outcomes, but also on observations of patients for up to 6 months after surgery.…”

Section: In In Patients Undergoing Esophagectomymentioning

confidence: 99%

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Effects of Enteral Immunonutrition in Esophageal Cancer

Mimatsu

Fukino

Ogasawara

et al. 2017

Gastrointest Tumors

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Background: Immunonutrition (IN) significantly reduces the incidence of postoperative infectious complications and the length of hospitalization in patients undergoing major elective surgery for gastrointestinal malignances. However, the clinical benefit of IN in patients who have undergone esophagectomy for esophageal cancer is unclear. Moreover, the effect of enteral IN in patients during preoperative adjuvant chemoradiotherapy and in patients treated with concurrent chemoradiotherapy for advanced esophageal cancer is unknown. Summary: This review analyzes the evidence supporting the enteral administration of IN in patients who have undergone esophagectomy and/or chemoradiotherapy for esophageal cancer. Twelve trials that evaluated IN exclusively in patients who underwent esophagectomy were published between January 1980 and August 2017. Two trials concerning IN during chemoradiotherapy for esophageal cancer were identified in the same period. However, the evidence is insufficient to recommend enteral IN in patients who have undergone esophagectomy and/or chemoradiotherapy for esophageal cancer. Key Message: Further evidence from well-designed randomized controlled trials is required to verify the clinical benefits of enteral IN in patients undergoing esophagectomy and/or chemoradiotherapy for esophageal cancer. Practical Implications: Resolvins, which are generated from EPA, are novel anti-inflammatory lipid mediators and may play a key role in the resolution of acute inflammation when IN is supplemented with EPA in patients undergoing severely stressful operations.

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Does Prolonged Enteral Feeding With Supplemental Omega-3 Fatty Acids Impact on Recovery Post-esophagectomy

Abstract: The thesis that EPA impacts on anabolism, immune function, and clinical outcomes post-esophagectomy was not supported. Compliance with home EN was excellent, but weight, muscle, and fat loss was significant in 30% of patients, highlighting the complexity of postoperative weight loss.

Cited by 43 publications

References 44 publications

Preoperative nutritional optimization of esophageal cancer patients

Preoperative nutritional optimization of esophageal cancer patients

Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

Effects of Enteral Immunonutrition in Esophageal Cancer

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