Na Kwon Joong, Kang Chang Hyun, Kim Young Ran, Kang Mi Jin, Song Eun Hwa, Jang Eun Joo, Park Samina, Lee Hyun Joo, Park In Kyu, Kim Young Tae
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Cancer Research Institute, Seoul National University Hospital.
Ann Surg. 2025 Mar 1;281(3):388-394. doi: 10.1097/SLA.0000000000006441. Epub 2024 Jul 12.
To compare nutritional and postoperative outcomes between early oral feeding and late oral feeding with jejunostomy feeding support after esophagectomy.
Esophagectomy is associated with substantial body weight loss and malnutrition, impacting the prognosis of esophageal cancer patients. Despite many studies on postesophagectomy nutritional support, optimal strategies remain elusive. This study investigates the impact of jejunostomy feeding with late oral feeding compared to conventional oral feeding on nutritional and postoperative outcomes.
We performed a single-center prospective open-labelled randomized controlled trial between 2020 and 2022. Patients aged 18 to 75 years with resectable esophageal cancer were randomly assigned to undergo either early oral feeding (early group) or late oral feeding with jejunostomy feeding support (late group) after esophagectomy. The primary endpoint was body weight loss from preoperative body weight at postoperative 4 to 5 weeks and 4 months. Other perioperative and nutritional outcomes were also evaluated.
We randomly assigned 29 patients to the early group and 29 patients to the late group. The late group exhibited significantly less body weight loss at both postoperative 4 to 5 weeks (8.3% vs. 5.6%; P =0.002) and 4 months (15.0% vs. 10.5%; P =0.003). The total calorie intake and protein intake were higher in the late group for both postoperative 4 to 5 weeks (1800 kcal/day vs. 1100 kcal/day; P <0.001) and 4 months (1565 kcal/day vs. 1200 kcal/day; P =0.010). Sixty percentage of the early group changed to malnutrition state, while 40% of the late group changed to malnutrition. The complication rate and length of hospital stays were similar.
The late group demonstrated prevention of significant body weight loss, enhanced nutritional intake, and reduced malnutrition without compromising short-term surgical outcomes.
比较食管癌切除术后早期经口进食与晚期经口进食并辅以空肠造口喂养支持的营养及术后结局。
食管癌切除术会导致显著的体重减轻和营养不良，影响食管癌患者的预后。尽管对食管癌切除术后的营养支持进行了许多研究，但最佳策略仍不明确。本研究调查了与传统经口进食相比，晚期经口进食并辅以空肠造口喂养对营养及术后结局的影响。
我们在2020年至2022年间进行了一项单中心前瞻性开放标签随机对照试验。年龄在18至75岁之间、可切除食管癌患者在食管癌切除术后被随机分配接受早期经口进食（早期组）或晚期经口进食并辅以空肠造口喂养支持（晚期组）。主要终点是术后4至5周和4个月时相对于术前体重的体重减轻情况。还评估了其他围手术期和营养结局。
我们将29例患者随机分配至早期组，29例患者随机分配至晚期组。晚期组在术后4至5周（8.3%对5.6%；P =0.002）和4个月（15.0%对10.5%；P =0.003）时体重减轻均显著较少。晚期组术后4至5周（1800千卡/天对1100千卡/天；P <0.001）和4个月（1565千卡/天对1200千卡/天；P =0.010）的总热量摄入和蛋白质摄入均较高。早期组60%转变为营养不良状态，而晚期组40%转变为营养不良。并发症发生率和住院时间相似。
晚期组在不影响短期手术结局的情况下，表现出预防显著体重减轻、增加营养摄入和减少营养不良的效果。
