Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Abstract

Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy. Variation in practices during the perioperative period exists including the type of nutrition started, the delivery route, and its timing. Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery, which can affect their ability to regain or maintain weight. Methods of feeding after an esophagectomy include total parenteral nutrition, nasoduodenal/nasojejunal tube feeding, jejunostomy tube feeding, and oral feeding. Recent evidence suggests that early oral feeding is associated with shorter LOS, faster return of bowel function, and improved quality of life. Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe, feasible, and cost-effective, albeit with limited data. However, data on anastomotic leaks is mixed, and some studies suggest that the incidence of leaks may be higher with early oral feeding. This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach. No definitive data is currently available to definitively answer this question, and further studies should look at how these early feeding regimens vary by surgical technique. This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.

Keywords: Esophagectomy, Oral feeding, Early feeding, Delayed feeding, Enteral nutrition, Esophageal cancer, Jejunostomy tube, Postoperative complications

Core tip: Early artificial enteral nutrition after esophagectomy is superior to total parenteral nutrition with regards to complication rate and functional recovery. Early direct oral nutrition appears to be safe in some patients, but there is some evidence associating early feeding with increased anastomotic leaks. For many patients who develop postoperative complications precluding oral intake, jejunostomy tubes remain an important option for nutritional delivery, although they are not without their own associated complications. Enhanced recovery pathways after surgery still vary in terms of these feeding techniques and schedules; more high-level evidence is required to make sweeping recommendations on early feeding after esophagectomy.