Algorithm of postoperative nutritive support after subtotal esophagectomy with gastric tube reconstruction

• Natalia B. Kovalerova
• Ruchkin D.V.

Abstract

Background. Enteral nutrition is generally accepted method of nutritional support in esophageal surgery. In most cases, it is carried out through a nasoejunal tube or jejunostomy. But tube feeding leads to complications that slow down the rehabilitation of patients in the postoperative period. At the same time, early oral intake of nutrients is traditionally considered to increase the frequency of anastomosis failure, although in other areas of surgery this method of nutritional support is the most preferred.

Aims – to improve the results of treatment in patients after subtotal esophagectomy with gastric tube reconstruction by choosing a method of nutritional support and to assess the nutritional status of patients with early oral feeding (EOF).

Material and methods. We’ve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. The study included only patients without a high risk of developing nutritional insufficiency. The patients were divided into two groups: the main group (n=30) with EOF from the 1st postoperative day (POD), and the control group (n=30) with the classical nutritional support scheme (parenteral nutrition for  4 POD). In the postoperative period, the results of treatment, the frequency and character of complications were evaluated, as well as the amount of prealbumin in blood plasma at 1, 3 and 6 POD.

Results. The patients of EOF group had statistically significant earlier gas discharge (2 [2; 3] POD vs 4 [3; 6] POD, р=0.000042) and stool appearance (3 [2; 4] POD vs 5 [4; 7] POD, р=0.000004). There is a tendency of reduction of the duration of postoperative hospitalization in EOF group  (8 [7; 9] POD vs 9 [8; 9] POD, р=0.13). EOF does 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 3 POD in EOF group (0.17 [0.13; 0.21] vs 0.2 [0.16; 0.34], р =0.03) of due to inability to compensate daily calorie needs in the first days after the operation. At 6 POD prealbumin became the same in both groups. There were no other significant differences between the groups. After the end of the study, we formulated an algorithm for choosing a variant of nutritional support after esophagectomy with gastric tube reconstruction, including all patients seeking surgical help.

Conclusion. EOF after esophagectomy with immediate gastric tube reconstruction is safe and effective. EOF doesn’t increase the frequency of anastomotic insufficiency and other complications and accelerates the patients’ rehabilitation after surgery. If the criteria of surgical safety are met, it is advisable to include EOF in the protocol of perioperative management of esophagectomy as part of the early rehabilitation program.

Keywords:esophagectomy; esophagoplasty; nutrition support; early oral feeding; enhanced recovery after surgery

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