title: An investigation into the current peri-operative nutritional management of oesophageal carcinoma patients in major carcinoma centres in England.
abstract: BACKGROUND
  Patients with oesophageal carcinoma are at high risk of malnutrition. The aim of this study was to assess current practice for the nutritional management of patients following surgery for oesophageal carcinoma.
  
  
  METHODS
  A postal questionnaire was sent to 82 dietetic departments of those hospitals in England identified as major centres for upper gastrointestinal surgery.
  
  
  RESULTS
  Of the 66 (80%) responses received, 22 (33%) centres routinely perform pre-operative nutritional screening/assessment on oesophageal carcinoma patients. Centres with dietetic support dedicated to these patients are more likely to perform a pre-operative nutritional assessment (n = 17; 55%) than those without (n = 5; 14%; P < 0.001; chi(2) = 12.17). Pre-operative nutritional support is routinely provided in only 11 (17%) centres with the majority of centres (n = 50; 75%), providing it if patients are considered malnourished only. A total of 47 (70%) centres routinely provide postoperative nutritional support with jejunal feeding being the most commonly chosen route. Dedicated dietetic support is provided at 31 (47%) centres. Those centres with a dedicated dietitian are more likely to provide early postoperative nutritional support (n = 27; 87%) than those without (n = 20; 57%; P = 0.007; chi(2) = 7.195) and more likely to review patients routinely following discharge from hospital (n = 25 [81%] with a dietitian versus n = 17 [49%] without; P = 0.007; chi(2) = 7.2).
  
  
  CONCLUSIONS
  The nutritional management of patients following surgery for upper gastrointestinal carcinoma is not uniform with practice varying considerably between centres. Those centres with a dedicated dietitian are more likely to assess patients' nutritional status and provide nutritional support.
authors.affiliation: Department of Nutrition and Dietetics, Plymouth Hospitals NHS Trust, Derriford, Plymouth, UK. paula.murphy@phnt.swest.nhs.uk
authors.forename: P M
authors.initials: PM
authors.lastname: Murphy
authors.forename: P
authors.initials: P
authors.lastname: Modi
authors.forename: J
authors.initials: J
authors.lastname: Rahamim
authors.forename: T
authors.initials: T
authors.lastname: Wheatley
authors.forename: S J
authors.initials: SJ
authors.lastname: Lewis
mesh_terms: D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D002985:Clinical Protocols; D004045:Dietary Services / Q000600:supply & distribution; D004739:England; D004938:Esophageal Neoplasms / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D018529:Nutritional Support / Q000706:statistics & numerical data*