Effects Of Preoperative Enteral Nutrition On Postoperative Recent Nutritional Status In Patients With Siewert ? And ? Adenocarcinoma Of Esophagogastric Junction After Neoadjuvant Chemoradiotherapy

Objective: To study the effects of preoperative enteral nutrition(EN)on the postoperative recent nutritional status(PRNS)in patients with Siewert II and III adenocarcinoma of esophagogastric junction(AEG)after neoadjuvant chemoradiotherapy(NCRT).Methods: The 66 adult participants enrolled under the clinical trial NCT01962246 were randomly divided into 2 groups.The research group accepted oral nutrition supplementation(ONS)for 7 days before surgery while the control group did not receive EN intervention before surgery.Both groups were supported by early EN after surgery.All participants were measured for body mass index(BMI)and relevant laboratory test [e.g.serum prealbumin(PA),total protein(TP),albumin(ALB),diamine oxidase(DAO)and D-lactate] were also examined and recorded within 48 hours of first hospitalization,the 1st day after NCRT,and the 1st and 8th day after surgery.In addition,NRS2002 and PG-SGA were applied for nutritional screening and evaluation.Moreover,injuries in intestinal mucosa were examined using optical microscope and scanning electron microscope(SEM).The difference in gastrointestinal recovery(flatus and defecation),the duration and cost of hospitalization,and complication incidence between the two groups were evaluated.Hierarchical analysis was applied to evaluate impact of preoperative EN on PRNS in patients with or without nutritional risk at admission,and logistic regression model was performed to analyze the risk factors of PRNS.Results:1 The BMI and levels of PA,TP and ALB were higher in research groupthan the controls at the 1st and 8th day after the surgery(P<0.05).Similarly,the rate of malnutrition and nutritional risk became lower in the research group at the 8th days after surgery(P<0.05).2 The levels of the DAO and D-lactate were signally lower in research group than the controls at the 1st and 8th day after the surgery(P<0.05).Injury levels of gastrointestinal mucosa observed under optical microscope and SEM were more severe among control group.3 The gastrointestinal function of patients in research group recovered faster than the controls,with a shorter-term use of stomach/peritoneal cavity drainage tubes,shorter hospital stays,less complications and costings(P<0.05).4 For patients with or without nutritional risk at admission,preoperative EN intervention resulted in higher PA,TP and ALB,and shorter time of postoperative flatus and defecation in research group than in controls at the 1st and 8th day after the surgery.5 Result of Logistic regression analysis suggested that preoperative EN could be an independent protective factor of PRNS,with an odd ratio(OR)of0.166 and the 95% confidence interval between 0.040 and 0.687(P=0.013).Conclusion:1 Preoperative EN may improve the PRNS of patients with Siewert II and III AEG after neoadjuvant chemoradiotherapy.2 Preoperative EN could enhance the recovery of impaired intestinal function and protect the intestinal mucosal barrier.3 Preoperative EN could decrease the incidence rate of postoperative complication,prompt recovery,shorten hospital stays and reduce hospital cost.4 For patients with or without nutritional risks at admission,an oral nutrition supplementation(ONS)should be supplied for 7 days before surgery.5 Preoperative EN was an independent protective factor of PRNS by using Logistic regression analysis.