Impact of systematic enteral nutrition on postoperative complications and oncological outcome in a curative multimodal strategy for esophageal cancer

Abstract

Background: Preoperative nutritional management is a challenging factor in the therapeutic management of curative esophageal cancer. This study aimed to evaluate the effect of early systematic enteral nutrition (SEN), initialized before the start of neoadjuvant treatment, on the rate of postoperative complications and on overall survival (OS) and disease-free survival (DFS).

Methods: A total of 313 patients without severe weight loss of <20% and with moderate dysphagia Atkinson stage III or less who were operated for curable esophageal cancer were included in the study. Patients who received SEN (n = 140) were compared with patients who received enteral nutrition on demand (END) (n = 173).

Results: After adjustment for baseline differences, no significant difference was observed between the SEN and END groups regarding the risk of severe complications (25.7% vs 24.9%, respectively; adjusted P =.682), the median comprehensive complication index (20.9 vs 20.9, respectively; adjusted P =.08), and the 90-day mortality (4.3% vs 5.2%, respectively; adjusted P =.706). In the case of perioperative chemotherapy, the rate of patients who completed the therapeutic sequence was higher in the SEN group than in the END group (odds ratio, 2.5; 80.4% vs 62.2%, respectively; P =.02). OS and DFS were similar between the groups (P =.546 and P =.600, respectively).

Conclusion: In patients with resectable esophageal cancer, SEN did not have a significant effect on postoperative course or survival results compared with END. Patients in the SEN group more frequently completed the therapeutic sequence in the case of perioperative chemotherapy.

Keywords: Esophageal cancer; Neoadjuvant treatment; Postoperative complications; Survival; Systematic enteral nutrition.