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Early Enteral Nutrition Versus Parenteral Nutrition After Resection of Esophageal Cancer: a Retrospective Analysis

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Abstract

This study aimed to compare the clinical outcomes and hospitalization cost between early enteral nutrition (EEN) and parenteral nutrition (PN) after resection of esophageal cancer. A total of 79 patients with esophageal cancer who underwent surgical treatment in our hospital from July 2010 to July 2013 were enrolled in this study. They were divided into EEN group (n = 39) and PN group (n = 40) based on the nutrition support modes. The clinical factors such as time to first fecal passage, postoperative albumin infusion, differences of serum albumin value, hospital stay, systematic inflammatory response syndrome (SIRS) duration, complications, initial hospitalization cost, and mortality were retrospectively compared. The EEN group had a significantly shorter hospital stay, lower initial hospitalization cost, earlier first fecal passage, and shorter duration of SIRS than PN group (P < 0.05). The dose of albumin infusion was significantly smaller in EEN group (P < 0.05) and the decreased value of serum albumin (Δalb) was more prominent in PN group compared with EEN group (P < 0.05). The percentage of patients having any postoperative complication was much higher in PN group than EEN group (P < 0.05), but there was no significant difference in in-hospital morbidity between two groups. Pneumonia was found significantly more frequent in PN group compared with EEN group (P < 0.05). Early EN started within 48 h after esophagectomy is safe, economic, and superior for reduction of postoperative complication, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation.

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References

  1. Wang JB, Fan JH, Liang H, Li J, Xiao HJ, Wei WQ, Dawsey SM, Qiao YL, Boffetta P (2012) Attributable causes of esophageal cancer incidence and mortality in China. PLoS One 7(8):e42281. doi:10.1371/journal.pone.0042281

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379(9829):1887–1892. doi:10.1016/S0140-6736(12)60516-9

    Article  PubMed  Google Scholar 

  3. Bailey SH, Bull DA, Harpole DH, Rentz JJ, Neumayer LA, Pappas TN, Daley J, Henderson WG, Krasnicka B, Khuri SF (2003) Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg 75(1):217–222, discussion 222

    Article  PubMed  Google Scholar 

  4. Enzinger PC, Mayer RJ (2003) Esophageal cancer. N Engl J Med 349(23):2241–2252. doi:10.1056/NEJMra035010

    Article  CAS  PubMed  Google Scholar 

  5. Jiang K, Cheng L, Wang JJ, Li JS, Nie J (2009) Fast track clinical pathway implications in esophagogastrectomy. World J Gastroenterol 15(4):496–501

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cao S, Zhao G, Cui J, Dong Q, Qi S, Xin Y, Shen B, Guo Q (2013) Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer 21(3):707–714. doi:10.1007/s00520-012-1570-0

    Article  PubMed  Google Scholar 

  7. Fujita T, Daiko H, Nishimura M (2012) Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer. European surgical research Europaische chirurgische Forschung Recherches chirurgicales europeennes 48(2):79–84. doi:10.1159/000336574

    Article  CAS  PubMed  Google Scholar 

  8. Page RD, Oo AY, Russell GN, Pennefather SH (2002) Intravenous hydration versus naso-jejunal enteral feeding after esophagectomy: a randomised study. Eur J Cardiothorac Surg 22(5):666–672

    Article  PubMed  Google Scholar 

  9. Watters JM, Kirkpatrick SM, Norris SB, Shamji FM, Wells GA (1997) Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility. Ann Surg 226(3):369–377, discussion 377-380

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Llop-Talaveron JM, Farran-Teixidor L, Badia-Tahull MB, Virgili-Casas M, Leiva-Badosa E, Galan-Guzman MC, Miro-Martin M, Aranda-Danso H (2014) Artificial nutritional support in cancer patients after esophagectomy: 11 years of experience. Nutr Cancer 66(6):1038–1046. doi:10.1080/01635581.2014.939292

    Article  CAS  PubMed  Google Scholar 

  11. Sobin LH, Wittekind C (2002) TNM Classification of Malignant Tumours, 6th edn. John Wiley & Sons, Hoboken, New York

    Google Scholar 

  12. Smith T, Elia M (2006) Artificial nutrition support in hospital: indications and complications. Clin Med 6(5):457–460. doi:10.7861/clinmedicine.6-5-457

    Article  Google Scholar 

  13. Kosugi S, Kanda T, Yajima K, Ishikawa T, Hatakeyama K (2011) Risk factors that influence early death due to cancer recurrence after extended radical esophagectomy with three-field lymph node dissection. Ann Surg Oncol 18(10):2961–2967. doi:10.1245/s10434-011-1712-5

    Article  PubMed  Google Scholar 

  14. Gabor S, Renner H, Matzi V, Ratzenhofer B, Lindenmann J, Sankin O, Pinter H, Maier A, Smolle J, Smolle-Juttner FM (2005) Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction. Br J Nutr 93(4):509–513

    Article  CAS  PubMed  Google Scholar 

  15. Sweeney KJ, Kell MR, Ravi N, Reynolds JV (2005) Major upper gastrointestinal surgery is associated with an antigen-dependent proinflammatory T cell response. Br J Surg 92(8):989–995. doi:10.1002/bjs.4844

    Article  CAS  PubMed  Google Scholar 

  16. Heyland DK, Cook DJ, Guyatt GH (1993) Enteral nutrition in the critically ill patient: a critical review of the evidence. Intensive Care Med 19(8):435–442

    Article  CAS  PubMed  Google Scholar 

  17. Mochizuki H, Trocki O, Dominioni L, Brackett KA, Joffe SN, Alexander JW (1984) Mechanism of prevention of postburn hypermetabolism and catabolism by early enteral feeding. Ann Surg 200(3):297–310

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Fong YM, Marano MA, Barber A, He W, Moldawer LL, Bushman ED, Coyle SM, Shires GT, Lowry SF (1989) Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans. Ann Surg 210(4):449–456, discussion 456-447

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Saito H, Trocki O, Alexander JW, Kopcha R, Heyd T, Joffe SN (1987) The effect of route of nutrient administration on the nutritional state, catabolic hormone secretion, and gut mucosal integrity after burn injury. JPEN J Parenter Enteral Nutr 11(1):1–7

    Article  CAS  PubMed  Google Scholar 

  20. Lin MT, Saito H, Fukushima R, Inaba T, Fukatsu K, Inoue T, Furukawa S, Han I, Muto T (1996) Route of nutritional supply influences local, systemic, and remote organ responses to intraperitoneal bacterial challenge. Ann Surg 223(1):84–93

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, Kellum JM Jr, Welling RE, Moore EE (1992) Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 216(2):172–183

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Mercer CD, Mungara A (1996) Enteral feeding in esophageal surgery. Nutrition 12(3):200–201

    Article  CAS  PubMed  Google Scholar 

  23. Aiko S, Yoshizumi Y, Sugiura Y, Matsuyama T, Naito Y, Matsuzaki J, Maehara T (2001) Beneficial effects of immediate enteral nutrition after esophageal cancer surgery. Surg Today 31(11):971–978

    Article  CAS  PubMed  Google Scholar 

  24. Ryan AM, Rowley SP, Healy LA, Flood PM, Ravi N, Reynolds JV (2006) Post-oesophagectomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit. Clin Nutr 25(3):386–393. doi:10.1016/j.clnu.2005.12.003

    Article  PubMed  Google Scholar 

  25. Baigrie RJ, Devitt PG, Watkin DS (1996) Enteral versus parenteral nutrition after oesophagogastric surgery: a prospective randomized comparison. Aust N Z J Surg 66(10):668–670

    Article  CAS  PubMed  Google Scholar 

  26. Heslin MJ, Latkany L, Leung D, Brooks AD, Hochwald SN, Pisters PW, Shike M, Brennan MF (1997) A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann Surg 226(4):567–577, discussion 577-580

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Doig GS, Heighes PT, Simpson F, Sweetman EA, Davies AR (2009) Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med 35(12):2018–2027. doi:10.1007/s00134-009-1664-4

    Article  CAS  PubMed  Google Scholar 

  28. Manba N, Koyama Y, Kosugi S, Ishikawa T, Ichikawa H, Minagawa M, Kobayashi T, Wakai T (2014) Is early enteral nutrition initiated within 24 hours better for the postoperative course in esophageal cancer surgery? J Clin Med Res 6(1):53–58. doi:10.4021/jocmr1665w

    CAS  PubMed  Google Scholar 

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Authors’ Contributions

Huan Ming Yu and Cheng Wu Tang designed the study and wrote the manuscript, Qiu Qiang Chen, Yong Qiang Xu, and Ying Bao did the clinical and follow-up work, and Wen Ming Feng provided the collection of all the human material in addition to providing financial support for this work.

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Authors and Affiliations

  1. Department of Thoracic Surgery, First People’s Hospital Affiliated to Huzhou University Medical College, Huzhou, Zhejiang, China

    Huan Ming Yu & Qiu Qiang Chen

  2. Department of General Surgery, First People’s Hospital Affiliated to Huzhou University Medical College, Huzhou, Zhejiang, China

    Cheng Wu Tang, Wen Ming Feng, Yong Qiang Xu & Ying Bao

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  1. Huan Ming Yu
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  2. Cheng Wu Tang
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  3. Wen Ming Feng
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Correspondence to Cheng Wu Tang.

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The authors declare that they have no competing interest.

Ethics Approval and Consent to Participate

Written informed consent was obtained from all patients. Approval of the study was obtained from the Institutional Review Board.

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Yu, H.M., Tang, C.W., Feng, W.M. et al. Early Enteral Nutrition Versus Parenteral Nutrition After Resection of Esophageal Cancer: a Retrospective Analysis. Indian J Surg 79, 13–18 (2017). https://doi.org/10.1007/s12262-015-1420-7

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  • DOI: https://doi.org/10.1007/s12262-015-1420-7

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