Early Enteral Nutrition In Patients After Esophageal Cancer Surgery

Objective: To determine the effects of early enteral nutrition (EN) on nutritional status, the suppression of excessive systematic inflammatory responses, and immunological competence in patients following esophageal cancer surgery.Methods: Sixty patients who underwent the same elective operation for thoracic esophageal carcinoma were prospectively randomized into an early enteral nutrition (EN) group who received naso-duodenal infusion with Nutrison from postoperative day (pod) 1 and a parenteral nutrition (PN) group. The nutritional goal was 25-30 kcal/kg/day. Both groups received isocaloric and isonitrogenous nutritional formulas on the same postoperative day. Routine parameters, liver function parameters, nutritional parameters, systematic inflammatory responses, and immune status in the blood were measured preoperatively and on the 3rd, and 8th day postoperatively. Serum total protein(TP), albumin(Alb), prealbumin(PAB), and transferrin(TRF)were evaluated. Serum concentrations of C-reactive protein(CRP) ,IL-6 ,and TNF α were measured. Peripheral lymphocyte subpopulation, Natural killer (NK) cell activity, and immunoglobulin levels were also measured. Result: There were no significant differences in the results of all of above parameters in two groups before operation. Patients in the EN group tolerated enteral feeding well. The incidence of side effects of the nutrition was 56.67%(17/30) in the EN group, while 36.67%(17/30) in the PN group ,but generally mild .The serum levels of total bilirubin and direct bilirubin were significantly attenuated in the EN group after operation. Activity of ALT and AST in sera were significantly higher in the PN group after operation. On the pod3, all the serum protein parameters decreased significantly, and recovered gradually. There was no significant difference in TP and Alb between the two groups. On the pod8, serum PAB and TRF levels in the EN group were significant higher than in the PN group. CRP , IL-6 , and TNF- α in sera was significantly higher after operation in both groups. IN the EN group , however, significantly less CRP , IL-6 , and TNF- α production was observed on the pod3 and pod8. No significant changes of T lymphocyte subset parameters were observed in both groups. Activity of NK lymphocyte decreased significantly after operation. But there was no significant difference between the two groups. Serum IgG, IgA, and IgM levels were decreased slightly on the pod3. On the pod8 IgG, and IgM levels were significantly higher in the EN group.Conclusion: Enteral feeding via a naso-duodenal tube is safe and well tolerated after esophagectomy. EN may attenuate impairment of hepatic function after operation. EN provides better resume of hepatic protein synthesis.Early enteral nutrition may have beneficial effects on the suppression of excessive inflammatory responses and immunological competence in patients following esophagectomy. Patients undergoing radical esophageal surgery might benefit the most from early enteral nutrition.