Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Int J Clin Oncol. 2024 Jan;29(1):36-46. doi: 10.1007/s10147-023-02428-5. Epub 2023 Nov 23.
Enteral feeding (EF) is recommended to enhance nutritional status after esophagectomy; however, diarrhea is a common complication of EF. We investigated the clinical and prognostic impact of diarrhea during EF after esophagectomy.
One hundred and fifty-two patients who underwent transthoracic esophagectomy were enrolled. The King's stool chart was used for stool characterization. The short- and long-term outcomes were compared between a non-diarrhea (Group N) and diarrhea group (Group D).
A higher dysphagia score (≥ 1) was observed more frequently in Group D than in Group N (45.7% vs. 19.8%, p = 0.002). Deterioration of serum total protein, serum albumin, serum cholinesterase, and the prognostic nutritional index after esophagectomy was greater in Group D than in Group N (p = 0.003, 0.004, 0.014, and 0.001, respectively). Patients in Group D had significantly worse overall survival (OS) and recurrence-free survival (RFS) than those in Group N (median survival time (MST): OS, 21.9 vs. 30.6 months, p = 0.001; RFS, 12.4 vs. 27.7 months, p < 0.001). In stratified analysis due to age, although there was no difference in OS with or without diarrhea in young patients (MST: 24.1 months in a diarrhea group vs. 33.6 months in a non-diarrhea group, p = 0.218), patients in a diarrhea group had significantly worse OS than those in a non-diarrhea group in elderly patients (MST: 17.8 months vs. 27.9 months, p < 0.001).
Diarrhea during EF can put elderly patients at risk of postoperative malnutrition and a poor prognosis after esophagectomy.
肠内喂养（EF）被推荐用于增强食管切除术后的营养状况；然而，腹泻是 EF 的常见并发症。我们研究了 EF 期间腹泻对食管切除术后的临床和预后的影响。
共纳入 152 例行经胸食管切除术的患者。采用 King 粪便图表对粪便特征进行描述。比较非腹泻组（N 组）和腹泻组（D 组）之间的短期和长期结局。
D 组的吞咽困难评分（≥1）较 N 组更常见（45.7% vs. 19.8%，p=0.002）。D 组术后血清总蛋白、血清白蛋白、血清胆碱酯酶和预后营养指数的恶化程度均高于 N 组（p=0.003、0.004、0.014 和 0.001）。D 组的总生存（OS）和无复发生存（RFS）明显差于 N 组（中位生存时间（MST）：OS，21.9 与 30.6 个月，p=0.001；RFS，12.4 与 27.7 个月，p<0.001）。由于年龄的分层分析，尽管在年轻患者中，腹泻或无腹泻的 OS 没有差异（MST：腹泻组 24.1 个月，无腹泻组 33.6 个月，p=0.218），但在老年患者中，腹泻组的 OS 明显差于无腹泻组（MST：17.8 个月与 27.9 个月，p<0.001）。
EF 期间的腹泻可能使老年患者术后出现营养不良和预后不良的风险增加。
