The effect of early oral feeding after subtotal esophagectomy with immediate esophageal reconstruction on patients’ nutritional status: randomized single-center study

Abstract

BACKGROUND: The efficiency of early oral feeding in the postoperative period is well known. Though doctors still prefer other types of nutritional support after esophagectomy with immediate gastric tube reconstruction in the esophagus surgery.

AIMS: To compare the efficacy, safety and nutritional status of patients after esophagectomy with gastric tube reconstruction while beginning of oral and full parenteral nutrition in the early postoperative period.

MATERIALS AND METHODS: We’ve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. In the postoperative period we evaluated the results of treatment, the frequency and severity of complications, anthropometric and laboratory indicators of the nutritional status before the operation on the first, third and sixth postoperative days.

RESULTS: Patients without high risk of malnutrition were randomly divided in 2 groups: main group (n=30) starting early oral feeding on the first postoperative day and control group (n=30) that remained nil by mouth and got parenteral feeding within 4 postoperative days. The patients of early oral feeding group had statistically significant earlier gas discharge(2 vs 4 postoperative days, р=0.000042) and stool appearance (3 vs 5 postoperative days, р=0.000004). There was a tendency towards a decrease in the duration of postoperative hospitalization in early oral feeding group (8 vs 9 postoperative days, р=0.13). Early oral feeding did not affect on frequency (46.6% vs 53.3%, р=0.66) and character of postoperative complications. After evaluation of the parameters of nutritional status we found statistically significant decrease of prealbumin level on the third postoperative day in early oral feeding group (0.17 vs 0.2, р=0.03) of due to inability to compensate daily calorie needs in the first days after the operation. On the sixth postoperative day prealbumin became the same in both groups. There were no other significant differences between the groups.

CONCLUSIONS: Early oral feeding after esophagectomy with immediate gastric tube reconstruction is safe. Early oral feeding doesn’t increase the frequency of anastomotic insufficiency and other complications. The decrease of prealbumin on the third postoperative day was noted in early oral feeding group while evaluating nutritional status.

Keywords

esophagectomy / esophagoplasty / nutrition support / early oral feeding / enhanced recovery after surgery

RIGHTS & PERMISSIONS

Kovalerova N.B., Ruchkin D.V., Plotnikov G.P.