Immediate Postoperative Oral Nutrition Following Esophagectomy: A Multicenter Clinical Trial.
BACKGROUND
Immediate start of oral intake is beneficial following colorectal surgery. However, following esophagectomy the safety and feasibility of immediate oral intake is unclear, thus these patients are still kept nil by mouth. This study therefore aimed to determine the feasibility and safety of oral nutrition immediately after esophagectomy.


METHODS
A multicenter, prospective trial was conducted in 3 referral centers between August 2013 and May 2014, including 50 patients undergoing a minimally invasive esophagectomy. Oral nutrition was started postoperatively immediately (clear liquids on postoperative day [POD] 0, liquid nutrition on POD 1 to 6, solid food from POD 7). Nonoral enteral nutrition was started when <50% of caloric need was met on postoperative day POD 5 or when oral intake was impossible. A comparison was made with a retrospective cohort (n = 50) with a per-protocol delayed start of oral intake until POD 4 to 7.


RESULTS
The median caloric intake at POD 5 was 58% of required. In 38% of the patients nonoral nutrition was started, mainly due to complications (36%). The pneumonia rate was 28% following immediate oral intake and 40% following delayed oral intake (p = 0.202). The aspiration pneumonia rate was 4% in both groups. The anastomotic leakage rate was 14% after immediate oral intake versus 24% following delayed oral intake (p = 0.202). The 90-day mortality rate was 2% in both groups. Hospital stay and intensive care unit stay were significantly shorter following immediate oral intake.


CONCLUSIONS
Immediate start of oral nutrition following esophagectomy seems to be feasible and does not increase complications compared to a retrospective cohort and literature. However, if complications arise an alternative nutritional route is required. This explorative study shows that a randomized controlled trial is needed.
Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Teus J
TJ
Weijs
Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Gijs H K
GH
Berkelmans
Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Grard A P
GA
Nieuwenhuijzen
Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Annemarie C P
AC
Dolmans
Department of Surgery, ZGT Hospital, Almelo, the Netherlands.
Ewout A
EA
Kouwenhoven
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
Camiel
C
Rosman
Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Jelle P
JP
Ruurda
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
Frans
F
van Workum
Department of Surgery, ZGT Hospital, Almelo, the Netherlands.
Marc J
MJ
van Det
Department of Surgery, ZGT Hospital, Almelo, the Netherlands.
Luis C
LC
Silva Corten
Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Richard
R
van Hillegersberg
Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. Electronic address: misha.luyer@cze.nl.
Misha D P
MD
Luyer
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000503:physiopathology / Q000601:surgery; D016009:Chi-Square Distribution; D004750:Enteral Nutrition / Q000379:methods*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000628:therapy; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome