Home Enteral Nutrition After Minimally Invasive Esophagectomy Can Reduce The Risk Of Malnutrition

PurposeTo investigate the effect of 3 month home enteral nutrition (HEN) on nutritional status of esophageal cancer patients who were preoperatively malnourished after receiving Ivor Lewis minimally invasive esophagectomy (MIE).MethodsFrom October 2014 to October 2015, this retrospective study investigated 50 malnourished (PG-SGA stage B or C) patients with esophageal cancer were assigned to receive Ivor Lewis MIE (MIE group,25 cases) with laparoscopic jejuna feeding tube placement or open esophagectomy (OE group,25 cases) with nasojejunal feeding tube placement. After discharge, patients in the MIE group received home enteral nutrition (HEN) with 500-1000kcal/d for 3 months, while the OE group patients did not receive HEN, as nasojejunal feeding tubes had been removed.ResultsThe two groups were well balanced for baseline characteristics. With regard to postoperative complications, the frequencies of pneumonia (24% vs.52%, p=0.042) was significantly lower in the MIE group. According to the VAS pain score, patients in the MIE group had significantly less pain in the first 3 days after surgery than those in the OE group [2.0 (1.0-5.0) vs.4.0 (1.0-8.0),P=0.034]. The median ICU stay [3(1-4) vs.4(1-9),P=0.024] and hospital stay [15(13-25) vs.20(13-35),P<0.001] for the MIE group was significantly shorter than that for the OE group. Similarly, patients treated with 3 months HEN had a lower risk of malnutrition than patients did not receive HEN (PG-SGA score,5.6 vs.7.7, p<0.001). At the 3-month follow-up, BMI, albumin, total protein and hemoglobin values were significantly higher in the MIE group than in the OE group.ConclusionMinimally invasive Ivor Lewis esophagectomy and subsequent treatment with 3 months HEN can reduce the risk of malnutrition in preoperatively malnourished patients.