Randomized Clinical Trial of the Effects of Perioperative Use of Immune‐enhancing Enteral Formula on Metabolic and Immunological Status in Patients Undergoing Esophagectomy

Abstract

Perioperative use of IEEF caused a significant increase in the total lymphocyte count at 3 and 5 days after operation and caused a shift toward B cell proliferation, which may possibly be beneficial to decrease the incidence of postoperative infectious complications.

Grade of esophageal cancer and nutritional status impact on postsurgery outcomes

“…Patients who need palliative treatment due the advanced stage of the disease are often undernourished and present a high risk of complications and operational lethality, having to carefully look at the risks and benefits of the indicated treatment, as well as the level of nutritional compromise and possibilities of nutritional intervention. Modern palliative nutritional treatment has the aim and task to improve patient quality of life and prolong survival, which count on different intervention methods which must also interact with organic functions, and hormonal and inflammatory response (17,23,26) . This study confirms the importance of early diagnosis and treatment of the disease in the sense of impeding or retarding its worsening to preserve patient nutritional state, permit surgical intervention and radiotherapy treatments, with less postoperative morbidity and consequently better patient survival.…”

Anaesthesia during oesophagectomy

“…Sometimes it is warranted to delay surgery to supplement proteins as this might improve wound healing and prevent infections or anastomotic breakdown. Early involvement of physiotherapist to improve physical or cardiopulmonary fitness and a dietician for a good nutritional state seems rational but studies into the effect on outcome are contradictory (14)(15)(16)(17).…”

Effects of Enteral Immunonutrition in Esophageal Cancer

“…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.…”

“…However, thus far, trials have been conducted in heterogeneous patient groups [16], hampering the establishment of recommendations for specific patient groups. Although a few trials have included patients undergoing esophageal cancer resection [17][18][19], these patients generally comprised only a small subset of the total study population, and thus those trials are inadequate to prove the effectiveness of IN in patients with esophageal cancer. Moreover, the effects of enteral IN in patients during preoperative adjuvant chemoradiotherapy and in patients treated with concurrent chemoradiotherapy for advanced esophageal cancer are unknown.…”