Yang Yongbo, He Yan, Wei Wan, Wu Yaya, Chen Hong, Gao Yimei, Yan Wanpu, Fan Mengying, Ma Shaohua, Liang Zhen, Xiong Hongchao, Dai Liang, Chen Ke-Neng
First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing, China.
State Key Laboratory of Molecular Oncology, First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing, China.
J Thorac Dis. 2025 Aug 31;17(8):5442-5453. doi: 10.21037/jtd-2025-355. Epub 2025 Aug 27.
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.
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.
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)].
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.
虽然食管癌术后营养支持已有充分记录，但新辅助治疗期间营养干预的影响仍未得到充分研究。本研究探讨新辅助治疗期间营养支持在改善食管癌患者围手术期结局中的作用。
对454例接受新辅助治疗后的食管癌切除术患者进行回顾性分析。根据营养干预后的体重变化，将患者分为营养有效组（体重维持或增加，n = 304）和对照组（体重减轻，n = 150）。比较两组患者的术前营养状况、治疗完成情况、不良反应、术后病理结果和并发症。
与对照组相比，营养有效组表现为：（I）新辅助治疗期间营养状况改善，体重指数（BMI）变化更大（0.85±0.88对 -0.90±0.65kg/m²，P<0.001），营养风险筛查（NRS）评分降低（0.72±0.89对0.53±0.82，P = 0.03）；（II）新辅助治疗完成率更高（82.9%对74.7%，P = 0.04）；（III）新辅助治疗期间3级或更高等级不良反应的发生率更低（13.8%对21.3%，P = 0.04）；以及（IV）术后吻合口漏发生率降低（10.2%对17.3%，P = 0.03）。术后住院时间、3级或更高等级并发症或病理缓解率[肿瘤退缩分级（TRG）≤2、主要病理缓解（mPR）和病理完全缓解（pCR）]方面未观察到显著差异。
鼻胃管喂养在新辅助治疗期间的有效营养支持中起关键作用。有效的营养干预不仅能改善术前营养状况，提高新辅助治疗完成率，还能减轻3级或更高等级不良事件，降低吻合口漏发生率。此外，它可能有助于改善术后病理缓解。
