Planned Delay of Oral Intake After Esophagectomy Reduces the Cervical Anastomotic Leak Rate and Hospital Length of Stay

Abstract

Cervical anastomotic leak rates are high after esophagectomy. We examined the effect of a purposeful delay in institution of oral diet after esophagectomy on the leak rate and hospital length of stay. A retrospective analysis of 120 patients submitted to esophagectomy with cervical esophagogastric anastomosis was conducted. Eighty-seven resumed diet within 7 days of surgery (early eaters), and 33 had delayed diet until a mean of 12 days after surgery (late eaters). Mean age was 62.3 years; 98 patients were male. One hundred one resections were for cancer, and 49 % of cancer patients received neoadjuvant therapy. The overall leak rate was 17.5 %, and hospital length of stay was 10.9 days. Anastomotic leak rate was 3 % for late eaters versus 23 % for early eaters (OR of 9.57, p = 0.010). Hospital length of stay was 6 days for late eaters versus 11.8 days for early eaters (p < 0.001). Anastomotic leak was significantly associated with increased length of stay (p < 0.001), adding an average of 7.6 days to hospital stay. Respiratory complications (p < 0.001) and delayed gastric emptying (p = 0.014) were also independent predictors of increased length of stay, but early eater status was not. Delayed resumption of oral diet after esophagectomy significantly reduces cervical anastomotic leak rate and avoids the increased length of stay associated with leak.

Impact of postoperative complications on outcomes after oesophagectomy for cancer

“…Several strategies have been shown to protect against pulmonary complications and anastomotic leakage. For anastomotic leakage, this includes use of precise suturing techniques with prevention of tension and avoidance of reduction in perfusion of the conduit, reinforcement of the anastomosis with omentoplasty, and delaying oral intake after oesophagectomy. Pulmonary complications can be prevented by stopping smoking before surgery, perioperative pulmonary rehabilitation, minimally invasive surgery and effective pain management.…”

“…Pulmonary complications can be prevented by stopping smoking before surgery, perioperative pulmonary rehabilitation, minimally invasive surgery and effective pain management. Furthermore, it has been shown that complication rates after oesophagectomy are lower in high‐volume centres and that the use of enhanced recovery after surgery protocols can reduce duration of hospital stay.…”

Immediate Postoperative Oral Nutrition Following Esophagectomy: A Multicenter Clinical Trial

“…There are 2 comparative studies in which the effects of a 5-to 7-day nil-by-mouth regimen were compared to a prolonged nil-by-mouth regimen (even up to 1 month). Significantly reduced anastomotic leakage rates were observed when the start of oral intake was further delayed [27,28]. It is unclear, however, if the reduced anastomotic leakage rate was a consequence of a further delay in the start of oral intake, or should be attributed to the retrospective design with patient selection and multiple factors differing between groups.…”

Study protocol for the nutritional route in oesophageal resection trial: a single-arm feasibility trial (NUTRIENT trial)

“…In one study, it was shown that anastomotic leakage rates are lower when a radiographic contrast swallow was omitted postoperatively and patients were fed over a jejunostomy and kept nil-by-mouth for 4 weeks 14. A more recent study investigated a ‘planned delay of oral intake’ 15. However, owing to the retrospective nature of both studies, differences in definitions, selection and timing of oral intake, the results are difficult to interpret.…”