Feeding Challenges in Patients with Esophageal and Gastroesophageal Cancers

Abstract

Background: Patients undergoing treatment for esophagogastric or esophageal cancer are exposed to a considerably high risk of malnutrition due to early obstruction of the gastrointestinal passage. Presently most of the patients undergo modern multimodal therapies which require chemoradiation or chemotherapy ahead of surgery. Therefore reconstruction of the obstructed gastrointestinal passage is considerably delayed. Surgery as the only curative option after neoadjuvant treatment is the mainstay of therapy in this setting. However, many patients are at risk for the development of postoperative complications associated with the complexity of the surgical procedure. Therefore enteral feeding as a prerequisite to avoid malnutrition represents a special therapeutic challenge. Summary: This review describes the recent literature on the incidence and influence of perioperative malnutrition on oncologic outcome, measures to determine patients at risk, possible strategies to reduce or avoid malnutrition by supportive enteral/parenteral nutrition, implementation of the enhanced recovery after surgery programs and feeding routes, but also surgical and adjuvant procedures in the curative and palliative setting for patients undergoing treatment for gastroesophageal cancers. Key Messages: Appropriate identification of patients at risk is crucial to avoid malnutrition. Early nutritional interventions during multimodal/neoadjuvant treatment may be beneficial for weight loss reduction although the evidence is not conclusive. Pouch reconstructions during surgery should be applied in order to increase quality of life and eating capacity. Reduction of postoperative complications could provide potential benefits. In palliative patients, insertion of self-expanding metal stents can reduce dysphagia and improve quality of life, but does not prolong overall survival. Further evidence is required to determine the value of the procedures and measures described in this review. Practical Implications: Nutritional risk scoring should be performed for every gastroesophageal cancer patient. Sophisticated reconstruction methods and early recovery programs should be enforced to reduce perioperative starvation periods. Self-expanding metal stents should be used for palliative patients.

Nutrition in peri-operative esophageal cancer management

“…As a result of the permanent anatomical change after esophagectomy, esophageal cancer survivors often have symptoms from an impaired gastrointestinal function that may cause long-term, persistent weight loss and malnutrition, with severe implications for QoL, immune function, and survival [6,102]. In the first postoperative year, the most frequently reported symptoms are early satiety, postprandial dumping, inhibited passage due to high viscosity, reflux of food and/or fluids, and absence of hunger.…”

“…Significant weight loss is frequently encountered, which makes these patients vulnerable for malnutrition [6,7]. Given the late symptomatic manifestations of esophageal carcinoma, many patients present with advanced disease, resulting in poor survival rates, i.e.…”

“…In the years following surgery, patients often experience problems affecting nutritional status, such as diarrhea, appetite loss, nausea, and vomiting [11]. Improvement in outcome may be achieved by appropriate risk assessment [6,12,13], pre-optimization [14], use of multimodality treatment [3], centralization of esophageal cancer surgery [15], use of minimally invasive esophagectomy techniques [16,17], and an enhanced recovery in esophagectomy pathway [16,[18][19][20][21][22][23][24][25][26]. In many of these new developments, nutrition has an essential role.…”

Re‐embodying eating after surgery for oesophageal cancer: Patients' lived experiences of participating in an education and counselling nutritional intervention

“…Oesophageal malignancies are the sixth leading cause of cancer‐related mortality and the eighth most common cancer worldwide (Pennathur, Gibson, Jobe, & Luketich, ; Reim & Friess, ). The disease occurs more often in men than in women.…”

“…Other important factors are low socioeconomic status, poor oral hygiene and nutritional deficiencies. In contrast, adenocarcinoma is related to obesity, reflux and most importantly Barrett's oesophagus (Pennathur et al., ; Reim & Friess, ). Due to the obstruction of the gastrointestinal tract by cancer, many patients suffer from malnutrition before they are diagnosed.…”