The feeding route after esophagectomy: a review of literature

Abstract

Enhanced recovery programs effectively optimize perioperative care and reduce postoperative morbidity. In esophagectomy, several components of the ERAS program are successfully introduced. However, timing and type of postoperative feeding remain a matter of debate. Adequate nutritional support is essential in patients undergoing an esophagectomy. These patients often present with weight loss and their eating pattern is strongly altered by the procedure and reconstruction. Total parenteral nutrition (TPN) is associated with severe septic complications and enteral nutrition (EN) does not increase major complications. Therefore, early EN after esophagectomy is favored over TPN. However, with enteral feeding tubes minor complications occur frequently (13-38%) and in some cases this can hamper recovery. Based on experience in other types of upper gastro-intestinal surgery, early start of oral feeding could improve time to functional recovery after surgery. The total length of stay was significantly shorter in four prospective studies (6-12 8-13 days). However, large randomized controlled trials are lacking and the potential benefit of early oral feeding after esophageal surgery remains elusive. EN is nowadays the optimal feeding route after esophagectomy. TPN should only be used in specific cases in which EN is contraindicated. Early initiation of oral intake is promising and could improve postoperative recovery. However, further research is needed to substantiate these results.

Survey of nutritional practices in total gastrectomy and oesophagectomy procedures

“…It must be taken into account though, that following major upper gastrointestinal surgery, patients may not achieve nutritional targets through oral intake alone, necessitating the introduction of alternate nutritional support methods such as nasoenteric feeding or TPN. In addition, questions remain as to the safety of early oral intake following oesophagectomy given the potential risks of early conduit distension and worsening of anastomotic leakage . The systematic review of Findlay et al .…”

“…Nasoenteric feeding remains a relatively popular alternative to jejunostomy tube feeding owing to its ability to deliver nutritional support for patients in a less invasive manner. However, nasoenteric feeding is not without its risk of complications such as aspiration, occlusion and frequent dislocation, making it less attractive for surgeons and patients alike . A recent meta‐analysis by Wang et al .…”

“…Further research utilising qualitative methods is recommended to elucidate surgeon reasoning for their preferred practices and decision‐making rationale. The optimal means and duration of nutritional support for total gastrectomy and Ivor Lewis oesophagectomy patients remains unclear and further research is required to develop evidence‐based guidelines which can be implemented worldwide …”

“…In addition, questions remain as to the safety of early oral intake following oesophagectomy given the potential risks of early conduit distension and worsening of anastomotic leakage. 23,24 The systematic review of Findlay et al noted that early oral intake may be safe and beneficial following upper gastrointestinal resections; however, this was based on limited data which also included large numbers of total gastrectomy patients. 25 As such, further research into this area appears warranted.…”

“…However, nasoenteric feeding is not without its risk of complications such as aspiration, occlusion and frequent dislocation, making it less attractive for surgeons and patients alike. 7,23,27 A recent meta-analysis by Wang et al concluded that following major upper gastrointestinal operations, nasoenteric feeding is more likely to be an effective means of early postoperative nutritional support as compared to jejunostomy feeding. However, the study suggested that more well-designed randomised control trials are needed to support these findings.…”