The effect of early oral feeding after subtotal esophagectomy with immediate esophageal reconstruction on the patients’ nutritional status: randomized single-center study.

Background: The efficiency of early oral feeding (EOF) in the postoperative period is well known. Though in the esophagus surgery doctors still prefer another types of nutritional support after esophagectomy (EE) with immediate gastric tube reconstruction. Aims: to improve the results of patients treatment after EE with gastric tube reconstruction by choosing the method of nutritional support and to evaluate nutritional status of the patients with EOF. Materials and methods: weve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. In the postoperative period we evaluated the results of treatment, the frequency and severity of complications, as well as anthropometric and laboratory indicators of the nutritional status before the operation, on 1, 3 and 6 postoperative day (POD). Results: Patients without high risk of malnutrition were randomly divided in 2 groups: main group (n=30) starting EOF on the 1 POD and control group (n=30) that remained nil by mouth and got parenteral feeding within 4 POD. The patients of EOF group had statistically significant earlier gas discharge (2[2;3] POD vs 4[3;6] POD, р = 0,000042) and stool appearance (3[2;4] POD vs 5[4;7] POD, р = 0,000004). There is a tendency of reduction of the duration of postoperative hospitalization in EOF group (8[7;9] POD vs 9[8;9] POD, р=0,13). EOF does not affect on frequency (46,6% vs 53,3%, р=0,66) and character of postoperative complications. After evaluation of the parameters of nutritional status we found statistically significant decrease of prealbumin level on 3 POD in EOF group (0,17 [0,13;0,21] vs 0,2 [0,16;0,34], р=0,03) of due to inability to compensate daily calorie needs in the first days after the operation. At 6 POD prealbumin became the same in both groups. There were no other significant differences between the groups. Conclusions: EOF after EE with immediate gastric tube reconstruction is safe and effective. EOF doesnt increase the frequency of anastomotic insufficiency and other complications.