Early versus the traditional start of oral intake following esophagectomy for esophageal cancer: a systematic review and meta-analysis

Effects of Early Oral Feeding on Quality of Life Following Esophagectomy: A Systematic Review and Meta-Analysis

BACKGROUND

The role of early oral feeding (EOF) following esophagectomy remains debated. This study evaluates whether postoperative EOF improves patients' quality of life.

METHODS

A comprehensive search was performed across eight databases to identify relevant studies. The effects of continuous variables were assessed using the mean difference (MD). The effects of dichotomous variables were assessed using the relative risk (RR).

RESULTS

Seven studies were included in the analysis. EOF significantly improved postoperative overall quality of life [MD = 9.64, 95% CI (6.11, 13.16), p < 0.001], dysphagia [MD = -7.37, 95% CI (-14.32, -0.42), p = 0.040], and eating difficulty [MD = -6.72, 95% CI (-10.62, -2.82), p < 0.001]. However, no significant differences were observed in postoperative reflux [MD = -5.90, 95% CI (-12.52, 0.73), p = 0.080], esophageal pain [MD = -1.86, 95% CI (-5.51, 1.78), p = 0.320], anastomotic leakage [RR = 0.70, 95% CI (0.37, 1.35), p = 0.290], and pulmonary infection [RR = 0.44, 95% CI (0.15, 1.35), p = 0.150].

CONCLUSION

EOF after esophagectomy appears to improve patients' quality of life; however, these findings are constrained by the limited number and quality of studies. Further research is needed to validate these results.

Perioperative nutrition for gastrointestinal surgery: On the cutting edge

Evidence on perioperative nutrition interventions in gastrointestinal surgery is rapidly evolving. We conducted a narrative review of various aspects of nutrition support, including formula choice and route of administration, as well as duration and timing of nutrition support therapy. Studies have demonstrated that nutrition support is associated with improved clinical outcomes in malnourished patients and those at nutrition risk, emphasizing the importance of nutrition assessment, for which several validated nutrition risk assessment tools exist. The assessment of serum albumin levels has fallen out of favor, as it is an unreliable marker of nutrition status, whereas imaging evidence of sarcopenia has prognostic value and may emerge as a standard component of nutrition assessment. Preoperatively, evidence supports limiting fasting to reduce insulin resistance and improve oral tolerance. Benefits to preoperative carbohydrate loading remain unclear, whereas literature suggests preoperative parenteral nutrition (PN) may reduce postoperative complications in high-risk patients with malnutrition or sarcopenia. Postoperatively, early oral feeding is safe with benefits in time to return of bowel function and reduced hospital stay. There is a signal for potential benefit to early postoperative PN in critically ill patients, though evidence is sparse. There has also been a recent emergence in randomized studies evaluating the use of ω-3 fatty acids, amino acids, and immunonutrition. Meta-analyses have reported favorable outcomes for these supplements, though individual studies are small and with significant methodological limitations and risk of bias, emphasizing the need for high-quality randomized studies to guide clinical practice.

Esophagectomy-prevention of complications-tips and tricks for the preoperative, intraoperative and postoperative stage

Esophagectomy still remains the mainstay of treatment for localized esophageal cancer. Many progresses have been made in the technique of esophagectomy in the last decades but the overall morbidity for this operation remains formidable. Postoperative complication and mortality rate after esophagectomy are significant; anastomotic leak has an incidence of 11,4%. The occurrence of a complication is a significant negative prognostic factor for long term survival and is also linked to longer postoperative stay, a lower quality of life, increased hospital costs. Preventing the occurrence of postoperative morbidity and reducing associated postoperative mortality rate is a major goal for surgeons experienced in resective esophageal surgery. Many details of pre, intra and postoperative care for patients undergoing esophagectomy need to be shared among the professionals taking care of these patients (oncologists, dieticians, physiotherapists, surgeons, nurses, anesthesiologists, gastroenterologists) in order to improve the short and long term clinical results.

Cancers œsophagiens : nouveautés et défis des prises en charge chirurgicales

Surgical resection of esophageal carcinoma is one of the mainstays of curative treatment for these cancers. During the last decade, numerous improvements in surgical approaches and perioperative management of these patients have resulted in a decrease in postoperative morbidity and mortality. Thus, centralization of patients with esophagogastric adenocarcinoma in high volume center, development of minimally invasive surgery and improvements in surgical imaging have led to reduce mortality rate, major pulmonary complication rate and postoperative chylothorax rate. Optimization of postoperative management with enhanced recovery programs has meanwhile reduced the rate of major postoperative complication and the hospital length of stay. The objective of this review is to give an overview of novelties and challenges regarding surgical management of patients with esophageal carcinoma.