Impact of early enteral feed composition on the rate of chyle leak post-esophagectomy

Patients undergoing esophagectomy are at risk of malnutrition and benefit from perioperative enteral feeding. Esophagectomy carries a risk of chyle leak, and this risk may be influenced by early enteral feed composition. We evaluated the impact of early enteral medium-chain triglyceride-rich feed on the prevalence and severity of chyle leak post-esophagectomy, length of stay, and postoperative weight change. This retrospective study included consecutive patients undergoing esophagectomy at a single center between January 2015 and December 2022. Patients received enteral feed on postoperative days 1-5 with Nutrison Energy or Protein Plus Energy ('standard') (January 2015- June 2021) or Nutrison Peptisorb Plus High Energy High Protein ('HEHP') enteral feed (June 2021 to December 2022). All patients transitioned to 'standard' supplemental jejunal feeding on postoperative day 6 onwards and were discharged on oral IDDSI level 4 diet. Patients who did not commence early enteral feeding were excluded from analysis. A total of 329 patients were included. Patients who received early HEHP feed had fewer chyle leaks (5/52; 9.6%) compared with patients who received standard feed (68/277; 24.5%, P = 0.017). The HEHP group had a shorter total length of hospital stay (P = 0.011). Weight change from preoperative baseline was equivalent in both groups at 6 weeks (P = 0.066) and 3 months (P = 0.400). In the context of routine jejunostomy use and early enteral feeding post-esophagectomy, HEHP feed on postoperative days 1-5 was associated with significantly fewer chyle leaks and shorter length of stay compared with standard feed. No difference was noted in postoperative weight change between groups.

703 Is the Grass Always Greener on the Other Side? – How Do Breast Cancer Patients Feel About Moving to a ‘Green Hub’?

Aim

Between January and September 2020 our base hospital recorded zero COVID-19 incidence in breast surgery patients, in 30 days post-op, with stringent admission protocols including 14 days self-isolation, PCR testing, ‘green’ wards and designated ‘green’ theatres. However, as the UK entered its third lockdown in January 6th2021 the decision was made to move breast cancer surgery off-site to a ‘green hub’ 43 miles away. The aim of this study was to assess the impact this had on patients.

Method

Patients who had surgery moved off-site were requested to anonymously complete a questionnaire which was either posted or handed to them at follow-up. The questionnaire contained 11 Multiple Choice questions and a comments section.

Results

16 of 19 patients (84.21%) responded to the questionnaire. 16 of 16 (100%) understood the reason for the move. 2 (12.5%) stated that it increased anxiety/stress levels while 3 (18.75%) reported the opposite, and the remainder were neutral. 14 (87.5%) said the move made them feel safer, 1 (6.25%) did not feel safer, with the remaining 1 (6.25%) unsure. 15 (93.75%) felt they received enough information at base and 16 (100%) received sufficient discharge information at the ‘green hub’. All 16 (100%) were satisfied with the move off-site but only 15 (93.75%) supported the decision.

Conclusions

The responses indicate that the decision to move breast surgery off-site was supported and well understood. And while for a minority of patients this increased pre-operative anxiety/stress levels, it did make the majority feel safer.

EP.TH.335Through the Lens of a Pandemic: The Impact of COVID-19 on Breast Cancer

Aims

On March 11^th 2020 the UN accorded COVID-19 pandemic status. On March 15^th, the Association of Breast Surgery released guidelines in light of the pandemic. Eight days later the UK government announced the first lockdown. GP referrals fell in April/May. The aim of this study is to review how COVID-19 affected breast cancer management.

Methods

This is a retrospective analysis of patients diagnosed with breast cancer attending their initial appointment between March 16^th to September 18^th (pandemic phase) and 1^st January to 15^th March(pre-pandemic). Primary outcomes were pandemic-related modification of treatment plans, and diagnosis of COVID-19 or related complications. Secondary outcomes were delay in presentation or advanced disease. B-Map-C and the CovidSurg Collaborative were used as Gold Standards.

Results

39 patients were in the pandemic phase and 45 in the pre-pandemic. 3/39(7.69%) and 14/45(31%) had surgery delayed. There were no COVID diagnoses. In-situ cancers were held on a deferred list until local guidelines changed. 2 patients had interim endocrine therapy. 9/39 underwent chemotherapy, of which 4 were neoadjuvant. 2/39 patients presented late to their GP, of which one had widespread metastases. 9/39(23.08%) were lymph node positive. In the pre-pandemic group, 6/45(13.3%) were lymph node positive, 2/45(4.4%) had distant metastases.

Conclusions

This study shows that breast surgery can be safely carried out during this pandemic and treatment postponement should be avoided as the pandemic continues. It remains to be seen if delayed treatments during 2020 will impact on local relapse and overall survival rates.