Effects of nutritional support during neoadjuvant therapy on perioperative outcome in esophageal cancer: a real-world cohort study.

BACKGROUND

While postoperative nutritional support for esophageal cancer is well-documented, the impact of nutritional intervention during neoadjuvant therapy remains understudied. This study investigates the role of nutritional support during neoadjuvant therapy in improving perioperative outcomes for esophageal cancer patients.

METHODS

A retrospective analysis of 454 esophagectomy patients following neoadjuvant therapy was conducted. Patients were categorized into a nutrition effective group (weight maintenance or gain, n=304) and a control group (weight loss, n=150) according to their weight change after nutritional intervention. Preoperative nutritional status, therapy completion, adverse reactions, postoperative pathological outcomes, and complications were compared between groups.

RESULTS

Compared to the control group, the nutrition effective group demonstrated (I) improved nutritional status during neoadjuvant therapy with higher body mass index (BMI) changes (0.85±0.88 -0.90±0.65 kg/m, P<0.001) and reduced Nutritional Risk Screening (NRS) scores (0.72±0.89 0.53±0.82, P=0.03); (II) higher neoadjuvant therapy completion rate (82.9% 74.7%, P=0.04); (III) lower incidence of grade 3 or higher adverse reactions during neoadjuvant therapy (13.8% 21.3%, P=0.04); and (IV) reduced postoperative anastomotic leakage rates (10.2% 17.3%, P=0.03). No significant differences were observed in postoperative hospital stay, grade 3 or higher complications, or pathological response rates [tumor regression grade (TRG) ≤2, major pathological remission (mPR), and pathological complete remission (pCR)].

CONCLUSIONS

Nasogastric tube feeding plays a pivotal role in effective nutritional support during neoadjuvant therapy. Effective nutritional intervention not only improves preoperative nutritional status and enhances neoadjuvant therapy completion but also mitigates grade 3 or higher adverse events and reduces the incidence of anastomotic leakage. Additionally, it may potentially contribute to improved postoperative pathological remission.