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. 2019 Jun 14;11(6):1338.
doi: 10.3390/nu11061338.

Effect of Postoperative Oral Intake on Prognosis for Esophageal Cancer

Genya Okada  1   2 , Chika Momoki  3   4 , Daiki Habu  5 , Chisako Kambara  6 , Tamotsu Fujii  7 , Yasunori Matsuda  8 , Shigeru Lee  9 , Harushi Osugi  10   11
Affiliations

Effect of Postoperative Oral Intake on Prognosis for Esophageal Cancer

Genya Okada et al. Nutrients. .

Abstract

Background: Patients undergoing surgery for esophageal cancer are at risk of prolonged hospital stay for postoperative malnutrition. Postoperative early oral feeing is a part of the "enhanced recovery after surgery protocol" for coping with this risk. However, the usefulness of early oral intake during perioperatively is questionable.

Methods: In total, 117 patients treated surgically for esophageal cancer were analyzed in the study. We assessed the oral energy sufficiency rate per nutritional requirement (oral-E/NR) at the fourth week postoperatively and classified the patients into two groups: Poor oral intake group (POI group; <25% oral-E/NR) and the control group (≥25% oral-E/NR). We analyzed the relationship among postoperative oral intake and prognoses.

Results: The POI group had worse postoperative nutritional status and a lower survival rate than the control group. In a multivariate analysis, <25% oral-E/NR was one of the independent factors contributing to negative outcomes postoperatively (adjusted hazard ratio: 2.70, 95% confidence interval: 1.30-5.61).

Conclusions: In patients undergoing surgery for esophageal cancer, poor postoperative oral intake negatively affected not only on their postoperative nutritional status but also their overall prognosis. It is necessary to improve the adequacy of oral intake postoperatively for patients with esophageal cancer.

Keywords: administration; energy intake; esophagectomy; nutrition therapy; outcomes research/quality.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The distribution of oral-E/NR at the 4th week postoperatively.
Figure 2
Figure 2
Changes of energy intake for each administration route in hospital. Differences between two study groups and two study time points were analyzed using split-plot analysis of variance and Bonferroni adjustment for multiple comparisons. Data are shown as mean ± standard error. a, p < 0.05 (vs. control); b, p < 0.05 (vs. preoperatively); POI group, poor oral intake group.
Figure 3
Figure 3
Changes of nutritional status during the follow-up period. (a) from preoperatively to the 6th month postoperatively, (b) from preoperatively to the 4th week postoperatively. Differences between two study groups and two study time points were analyzed using split-plot analysis of variance and Bonferroni adjustment for multiple comparisons. Data are shown as mean ± standard error. a, p < 0.05 (vs. control); b, p < 0.05 (vs. preoperatively); c, p < 0.05 (vs. the fourth week postoperatively); BW/UBW, body weight at each study time points per usual body weight.
Figure 4
Figure 4
Kaplan–Meier estimates of the overall survival based on postoperative oral intake. (a) Overall survival, (b) stratification of patients by tumor stage (Stages 0–II and III–IV). Differences between the two groups were analyzed using the log-rank test and Bonferroni adjustment for multiple comparisons.
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