O3 Direct Oral Feeding Following Minimally Invasive Esophagectomy (Nutrient Ii Trial): An International, Multicenter, Open-Label Randomized Controlled Trial

Abstract

Aim Patients undergoing an esophagectomy are often kept nil-by-mouth postoperatively out of fear for increasing anastomotic leakage and pulmonary complications. This study investigates the effect of direct start of oral feeding following minimally invasive esophagectomy (MIE) compared to standard of care. Background & Methods Elements of enhanced recovery after surgery (ERAS) protocols have been successfully introduced in patients undergoing an esophagectomy. However, start of oral intake, which is an essential part of the ERAS protocols, remains a matter of debate. Patients in this multicenter, international randomized controlled trial were randomized to directly start oral feeding (intervention) after a MIE with intrathoracic anastomosis or to receive nil-by-mouth and tube feeding for five days postoperative (control group). Primary outcome was time to functional recovery. Secondary outcome parameters included anastomotic leakage, pneumonia rate and other surgical complications scored by predefined definitions. Results Baseline characteristics were similar in the intervention (n=65) and control (n=67) group. Functional recovery was seven days for patients receiving direct oral feeding compared to eight days in the control group (p-value 0.436). Anastomotic leakage rate did not differ in the intervention (18.5%) and control group (16.4%, p-value 0.757). Pneumonia rates were comparable between the intervention (24.6%) and control group (34.3%, p-value 0.221). Other morbidity rates were similar, except for chyle leakage which was more prevalent in the standard of care group (p-value 0.032). Conclusions Direct oral feeding after an esophagectomy does not affect functional recovery and did not increase incidence or severity of postoperative complications.

Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

“…The second part of this study investigated the postoperative micronutrient status of patients that participated in the NUTRIENT II trial (NCT02378948). The NUTRIENT II was a multicenter randomized controlled trial that investigated the influence of direct start of oral feeding with the standard of care (jejunostomy tube feeding and 5 days nil-by-mouth) on postoperative recovery following a minimally invasive Ivor-Lewis esophagectomy with intrathoracic anastomosis [22]. The NUTRIENT II database used for the purpose of the current study was already fully constructed and anonymized by the researchers.…”

Needle Catheter Jejunostomy in Patients Undergoing Surgery for Upper Gastrointestinal and Pancreato-Biliary Cancer–Impact on Nutritional and Clinical Outcome in the Early and Late Postoperative Period

“…The study is limited by the retrospective analysis and a potential selection bias. Since the evidence for early oral food intake after esophagectomy and gastrectomy came up more recently [ 2 , 40 ] the restrictions within the first days were very “traditional”. Nevertheless, all calorie intake will be inappropriate for a longer period of time.…”

“…In the time of Enhanced Recovery after Surgery programs (ERAS), perioperative nutrition therapy seems to be very “traditional” and even redundant [ 1 ]. Early oral feeding is feasible even after esophagectomy and without impact on the incidence and severity of postoperative complications [ 2 ].…”

Enhanced Recovery in Surgery for Gastric Cancer

“…Результаты мультицентрового РКИ NUTRI-ENT II показали, что начало перорального приема жидкой пищи на 1-й ПОД после мини-инвазивной эзофагэктомии не оказало статистически значимого влияния на скорость функционального восстановления и характер осложнений, в том числе частоту несостоятельности анастомоза [44]. В то же время суточный калораж при пероральном питании, начатом с 1-го ПОД, был статистически значимо ниже, чем в контрольной группе пациентов, получавших энтеральное питание через еюностому и начавших пероральное питание на 5-й ПОД (1220 и 1936 ккал соответственно, р < 0,001).…”