Effect of Early Full‐Calorie Nutrition Support Following Esophagectomy: A Randomized Controlled Trial

Wu, Wei; Zhong, Ming; Zhu, Dexiang; Song, Jieqiong; Huang, Junfeng; Wang, Qun; Tan, Lijie

doi:10.1177/0148607116651509

Cited by 20 publications

(23 citation statements)

References 35 publications

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“…A combination of EN and TPN might have some benefits when compared to TPN alone, such as improvement of intestinal integrity and stimulation of incretin production contributing to improved glucose control in patients undergoing esophagectomy [71]. Moreover, supplemental parenteral nutrition after esophagectomy contributes to better coverage of patients' calorie requirements, since large amounts of enteral nutrition are not usually tolerated in the first postoperative days [72].…”

Section: Enteral Versus Parenteral Nutritionmentioning

confidence: 99%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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Esophageal cancer is associated with malnutrition in the vast majority of patients. This phenomenon is partly attributed to the disease process itself, the location of the tumor and other factors, such as dysphagia which is often accentuated due to chemotherapy/ radiotherapy treatment or surgical intervention. The poor nutritional status of these patients is often related to the presence of cancer cachexia, altered metabolism, and tissue wasting. Malnutrition in this patient population affects quality of life, worsens patient's tolerance to chemotherapy and accounts for lower survival. Nutritional management of these patients includes both proper nutritional assessment and support and might prevent, to a certain extent, the manifestation of malnutrition-related consequences. The purpose of this article is to review the current literature in order to focus on the etiology and diagnosis of malnutrition in esophageal cancer patients, emphasizing also on the optimal nutritional support during multimodality treatment.

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Section: Enteral Versus Parenteral Nutritionmentioning

confidence: 99%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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“…It must be noted that this analysis did not include the trials by Ridley et al, 32 Berger et al, 33 and Herndon, 44,45 which may explain the differences to our results. 49 and the other owing to the inclusion of elective surgery patients, with 0% mortality, by Wu et al 50 ). In addition, the nonrandomized trials by Fan 47 and Huang 48 were included in their meta-analysis.…”

Section: Agreements and Disagreements With Other Reviewsmentioning

confidence: 99%

Combination of enteral and parenteral nutrition in the acute phase of critical illness: An updated systematic review and meta‐analysis

Hill

Heyland

Ortiz-Reyes

et al. 2021

J Parenter Enteral Nutr

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Background: Uncertainty remains about the best route and timing of medical nutrition therapy in the acute phase of critical illness. Early combined enteral nutrition (EN) and parenteral nutrition (PN) may represent an attractive option to achieve recommended energy and protein goals in select patient groups. This meta-analysis aims to update and summarize the current evidence.Methods: This systematic review and meta-analysis includes randomized controlled trials (RCTs) targeting the effect of EN alone vs a combination of EN with PN in the acute phase of critical illness in adult patients. Assessed outcomes include mortality, intensive care unit (ICU) and hospital length of stay (LOS), ventilation days, infectious complications, physical recovery, and quality-of-life outcomes.Results: Twelve RCTs with 5543 patients were included. Treatment with a combination of EN with PN led to increased delivery of macronutrients. No statistically significant effect of a combination of EN with PN vs EN alone on any of the parameters was observed: mortality (risk ratio = 1.0; 95% CI, 0.79-1.28; P = .99), hospital LOS (mean difference, −1.44; CI, −5.59 to 2.71; P = .50), ICU LOS, and ventilation days. Trends toward improved physical outcomes were observed in two of four trials. Conclusion:A combination of EN with PN improved nutrition intake in the acute phase of critical illness in adults and was not inferior regarding the patients' outcomes. Large, adequately designed trials in select patient groups are needed to answer the question of whether this nutrition strategy has a clinically relevant treatment effect.

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“…Heidegger et al (2013) (41) Wischmeyer et al (2017) (42) Allingstrup et al (2017) (11) Trial focus More recent nutrition studies have used physical outcome assessment, or surrogate parameters and some have revealed trends of improved functional outcomes in intense nutrition therapy groups (11,16,42,67) . In addition, Wu et al (68) observed unchanged 'classic' parameters such as hospital length of stay, postoperative morbidity rates, and standard blood biochemistry profiles, in a patient cohort after oesophagectomy. However, these patients had better physical functioning and less fatigue (68) .…”

Section: Focus On Functional Outcomesmentioning

confidence: 99%

“…In addition, Wu et al (68) observed unchanged 'classic' parameters such as hospital length of stay, postoperative morbidity rates, and standard blood biochemistry profiles, in a patient cohort after oesophagectomy. However, these patients had better physical functioning and less fatigue (68) .…”

Section: Focus On Functional Outcomesmentioning

confidence: 99%

Meeting nutritional targets of critically ill patients by combined enteral and parenteral nutrition: review and rationale for the EFFORTcombo trial

Hill

Heyland

Elke³

et al. 2020

Nutr. Res. Rev.

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While medical nutrition therapy is an essential part of the care for critically ill patients, uncertainty exists about the right form, dosage, timing and route in relation to the phases of critical illness. As enteral nutrition (EN) is often withheld or interrupted during the ICU stay, combined EN and parenteral nutrition (PN) may represent an effective and safe option to achieve energy and protein goals as recommended by international guidelines. We hypothesize that critically ill patients at high nutritional risk may benefit from such a combined approach during their stay on the intensive care unit (ICU). Therefore, we aim to test if an early combination of EN and high-protein PN (EN+PN) is effective in reaching calorie and protein goals in patients at high nutritional risk, while avoiding overfeeding. This approach will be tested in the here presented EFFORTcombo trial. Nutritionally high-risk ICU patients will be randomized to either high (≥2.2 mg/kg/d) or low protein (≤1.2 mg/kg/d). In the high protein group, the patients will receive EN+PN, in the low protein group, patients will be given EN alone. EN will be started in accordance to international guidelines in both groups. Efforts will be made to reach nutrition goals within 48–96 hours. The efficacy of the proposed nutritional strategy will be tested as an innovative approach by functional outcomes at ICU- and hospital-discharge, as well as at a 6-month follow-up.

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Effect of Early Full‐Calorie Nutrition Support Following Esophagectomy: A Randomized Controlled Trial

Abstract: Early use of supplemental PN to meet full calorie requirements of patients who underwent esophagectomy led to better quality of life 3 months after surgery. Moreover, increased calorie and protein supplies were associated with preservation of body weight and FFM.

Cited by 20 publications

References 35 publications

Nutritional Management of Esophageal Cancer Patients

Nutritional Management of Esophageal Cancer Patients

Combination of enteral and parenteral nutrition in the acute phase of critical illness: An updated systematic review and meta‐analysis

Meeting nutritional targets of critically ill patients by combined enteral and parenteral nutrition: review and rationale for the EFFORTcombo trial

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