title: Low fat-containing elemental formula is effective for postoperative recovery and potentially useful for preventing chyle leak during postoperative early enteral nutrition after esophagectomy.
abstract: Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery.
  
  
  
  A total of 74 patients who received TTE-3FL for esophageal cancer were retrospectively examined. Patients were classified into two groups according to the type of postoperative EN: Group LF patients received a low-fat elemental formula, and Group F patients received a standard fat-containing polymeric formula. The following clinical factors were compared between the groups: EN start day, maximum EN calories administered, duration of respirator use, length of ICU stay, incidence of postoperative infectious complications, use of parenteral nutrition (PN), and incidence of postoperative chyle leak.
  
  
  
  Patients in Group LF were started on EN significantly earlier after surgery and they consumed significantly higher maximum EN calories compared to Group F patients (P < 0.01). Duration of respirator use and length of ICU stay were also significantly shorter, and TPN was used significantly less in Group LF compared to Group F (P < 0.05). Postoperative chyle leak was observed in six patients in total (8.1%); five patients in Group F and one patient in Group LF, although there was no significant difference in frequency of chyle leak per patient between Group LF and Group F.
  
  
  
  Early EN using low-fat elemental formula after esophagectomy with three-field lymphadenectomy was safe and valid for postoperative recovery and potentially useful in preventing chyle leak.
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Moro
authors.affiliation: Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata, Niigata 951-8518, Japan. Electronic address: yukmy@clg.niigata-u.ac.jp.
authors.forename: Yu
authors.initials: Y
authors.lastname: Koyama
authors.affiliation: Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-Uonuma, Niigata, Japan.
authors.forename: Shin-Ichi
authors.initials: SI
authors.lastname: Kosugi
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ichikawa
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hanyu
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Miura
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nagahashi
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nakajima
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Tatsuda
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Tsuchida
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Toshikawa
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Mayuko
authors.initials: M
authors.lastname: Ikarashi
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Sakata
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kameyama
authors.affiliation: Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimachi, Niigata, Niigata 951-8510, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Wakai
mesh_terms: D000368:Aged; D002913:Chyle; D004041:Dietary Fats / Q000008:administration & dosage*; D004750:Enteral Nutrition; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057947:Parenteral Nutrition Solutions / Q000737:chemistry*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D004041:Dietary Fats; D057947:Parenteral Nutrition Solutions
keywords: Chyle leak; Early enteral nutrition; Esophageal cancer; Low fat-containing elemental formula; Thoracic duct