Nowadays, patients undergoing gastrointestinal surgery are following perioperative treatment in enhanced recovery after surgery (ERAS) protocols. Although oral feeding is supposed not to be stopped perioperatively with respect to ERAS, malnourished patients and inadequate calorie intake are common. Malnutrition, even in overweight or obese patients, is often underestimated. Patients at metabolic risk have to be identified early to confirm the indication for nutritional therapy. The monitoring of nutritional status postoperatively has to be considered in the hospital and after discharge, especially after surgery in the upper gastrointestinal tract, as normal oral food intake is decreased for several months. The article gives an overview of the current concepts of perioperative enteral nutrition in patients undergoing gastrointestinal surgery.

https://www.mdpi.com/2072-6643/13/8/2655/pdf

Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery.

Introduction We performed a meta-analysis to evaluate the influence of a home enteral nutritional support compared with a normal oral diet in postoperative subjects with upper gastrointestinal cancer resection. Methods A systematic literature search up to December 2021 was done and 23 studies included 3,010 subjects with upper gastrointestinal cancer resection at the start of the study; 1,556 of them were given home enteral nutritional support and 1,454 were normal oral diet. We calculated the odds ratio (OR) and mean difference (MD) with 95% CIs to evaluate the influence of home enteral nutritional support compared with a normal oral diet in postoperative subjects with upper gastrointestinal cancer resection by the dichotomous or continuous methods with a random or fixed-influence model. Results Home enteral nutritional support had significantly higher quality of life (MD, 2.08; 95% CI, 1.50–2.67, p < 0.001), better body weight change (MD, 1.87; 95% CI, 1.31–2.43, p < 0.001), higher albumin (MD, 1.27; 95% CI, 0.72–1.82, p < 0.001), and higher pre-albumin (MD, 30.79; 95% CI, 7.29–54.29, p = 0.01) compared to the normal oral diet in subjects with upper gastrointestinal cancer resection. However, home enteral nutritional support had no significant impact on the hemoglobin (MD, 4.64; 95% CI, −4.17 to 13.46, p = 0.30), and complications (OR, 1.03; 95% CI, 0.76–1.40, p = 0.83) compared to the normal oral diet in subjects with upper gastrointestinal cancer resection. Conclusions Home enteral nutritional support had a significantly higher quality of life, better body weight change, higher albumin, and higher pre-albumin, and had no significant impact on the hemoglobin and complications compared to the normal oral diet in subjects with upper gastrointestinal cancer resection. Further studies are required.

Effect of Home Enteral Nutritional Support Compared With Normal Oral Diet in Postoperative Subjects With Upper Gastrointestinal Cancer Resection: A Meta-Analysis

The study aimed to fully understand small bowel necrosis, a rare but fatal complication after esophagectomy.

Small bowel necrosis after esophagectomy

Abstract OBJECTIVES Preoperative selection bias led to the inability to generalize the proposed benefit of subxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) as having less postoperative pain than uniportal intercostal VATS. So, we conducted this prospective, single-blinded, randomized controlled trial to investigate the hypothesis that SVATS may have less early postoperative pain than UVATS in patients who undergo major lung resection for early-stage lung cancer. METHODSA total of 262 patients were randomly allocated between 2 groups (each with 131 patients), the first being the UVATS group and the second being the SVATS group. The values indicated on the numerical rating scale (NRS) of pain were collected at 24 h and 48 h during rest and during coughing. In addition, different perioperative variables were analysed and compared between the 2 groups. RESULTS Multiple linear regression analysis showed that the type of surgical approach was a significant predictor of the postoperative NRS values. The postoperative NRS pain values were significantly lower in the SVATS group after 24 h during rest and coughing and after 48 h during coughing. Postoperatively, patients in the SVATS group got out of bed significantly earlier [16.37 (2.54) vs 18.05 (3.29) h, p < 0.001]. The SVATS group showed a significantly higher rate of intraoperative arrhythmia [20 (15.3%) vs 3 (2.3%) patients, p = 0.03]. CONCLUSIONS SVATS major pulmonary resection in early-stage lung cancer is associated with less early postoperative pain than the UVATS approach. Operating on patients with cardiac problems using the SVATS approach is still a limiting factor for randomization due to the potential compression on the heart with resulting arrhythmia. Clinical trial registration The trial was registered under clinical trials.gov Identifier: NCT03331588. https://clinicaltrials.gov/ct2/show/NCT03331588.

/pdf/early-postoperative-pain-after-subxiphoid-uniportal-3fftbndp.pdf

Early postoperative pain after subxiphoid uniportal thoracoscopic major lung resection: a prospective, single- blinded, randomized controlled trial

Background: We performed a meta-analysis to evaluate the effect of home enteral nutrition compared with oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer. Methods: A systematic literature search up to July 2021 was performed and 12 studies included 970 subjects with esophagectomy of esophageal cancer at the start of the study; 481 of them were using home enteral nutrition after the hospital discharge and 579 were given oral diet. They were reporting relationships between the effects of home enteral nutrition compared with oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer. We calculated the odds ratio (OR) and the mean difference (MD) with 95% confidence intervals (CIs) to assess the effects of home enteral nutrition compared with oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer using the dichotomous and contentious method with a random or fixed-effect model. Results: Home enteral nutrition had significantly higher body weight (MD, 31.4; 95% CI, 2.55-3.72, p < 0.001), body mass index (MD, 1.20; 95% CI, 0.66-1.74, p < 0.001), and serum albumin (MD, 3.14; 95% CI, 2.07-4.20, p < 0.001), hemoglobin (MD, 8.57; 95% CI, 6.52–10.63, p < 0.001), total protein (MD, 4.86; 95% CI, 2.93-6.80, p < 0.001), and pre-albumin (MD, 30.39; 95% CI, 1.27-59.50, p = 0.04) compared to oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer. Additionally, home enteral nutrition compared with oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer had no significant difference in feeding-related complications (OR, 1.04; 95% CI, 0.44-2.43, p = 0.93). Conclusions: Home enteral nutrition had significantly higher body weight, body mass index, and serum albumin, hemoglobin, total protein, and pre-albumin compared to oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer with no significant difference in feeding-related complications. Furthers studies are needed to confirm these findings.

/pdf/evaluate-the-effect-of-home-enteral-nutrition-compared-with-3bnhw23028.pdf

Evaluate the Effect of Home Enteral Nutrition Compared with Oral Diet after the Hospital Discharge of Subjects with Esophagectomy of Esophageal Cancer: A Systemic Review and Meta-analysis

To systematically evaluate the safety and advantages of subxiphoid approach video-assisted thoracic surgery (SA-VATS) compared with intercostal approach video-assisted thoracic surgery (IA-VATS) fo...

Subxiphoid versus intercostal video-assisted thoracic surgery for lung resection: a meta-analysis

A Meta-analysis of Jejunostomy Versus Nasoenteral Tube for Enteral Nutrition Following Esophagectomy.

Feeding jejunostomy (FJ) is a routine procedure at the time of esophagectomy in some centers. With the widespread popularization of enhanced recovery after surgery, the necessity of FJ has been increasingly questioned. This study aims to analyze the differences in safety and effectiveness between with (FJ group) or without (no-FJ group) performing FJ at the time of esophagectomy. PubMed, Embase, Web of Science, and Cochrane Library were comprehensively searched for relevant studies, including randomized controlled trials and cohort studies. The primary outcome was the length of hospital stay (LOS). Secondary outcomes were overall postoperative complications, postoperative pneumonia, intestinal obstruction, and weight loss at 3 and 6 months after esophagectomy. Weighted mean differences (WMD) and odds ratios (OR) were calculated for statistical analysis. About 12 studies comprising 2,173 patients were included. The FJ group had a longer LOS (WMD = 2.05, P = 0.01) and a higher incidence of intestinal obstruction (OR = 11.67, P   0.05) after esophagectomy. Current evidence suggests that routinely performing FJ at the time of esophagectomy appears not to generate better postoperative outcomes. FJ may need to be performed selectively rather than routinely. More studies are required to further verify.

Is it necessary to routinely perform feeding jejunostomy at the time of esophagectomy? A systematic review and meta-analysis.

BACKGROUND Esophagectomy and definitive chemoradiotherapy are commonly used in the treatment of stage I esophageal cancer (EC). The present study aims to compare the efficacy and safety of esophagectomy and definitive chemoradiotherapy as the initial treatment for clinical stage I EC. METHODS This study was registered with the International Prospective Register of Systematic Reviews (CRD42020197203). Relevant studies were identified through PubMed, Web of Science, EMBASE, and Cochrane Library from database inception to June 30, 2020. Hazard ratio (HR) with 95% confidence intervals (CI) was employed to compare overall survival (OS) and progression-free survival (PFS). Odds ratio (OR) with 95% CI was employed to compare treatment-related death, complications, and tumor recurrence. RESULTS A total of 13 non-randomized controlled studies involving 3,346 patients were included. Compared with definitive chemoradiotherapy, esophagectomy showed an improved OS (HR 0.69, 95% CI 0.55-0.86; P < 0.001), PFS (HR 0.47, 95% CI 0.33-0.67; P < 0.001), and a lower risk of tumor recurrence (OR 0.43, 95% CI 0.30-0.61; P < 0.001). There was no significant difference in the incidence of complications (OR 1.11, 95% CI 0.75-1.65; P = 0.60) and treatment-related death (OR 1.15, 95% CI 0.31-4.30; P = 0.84) between the two treatments. CONCLUSIONS Current evidence shows esophagectomy has superior survival benefits as the initial treatment for clinical stage I EC. It is still the preferred choice for patients with clinical stage I EC. However, future high-quality randomized controlled trials are needed to validate this conclusion.

Yong Chen

Papers

Subxiphoid versus intercostal video-assisted thoracic surgery for lung resection: a meta-analysis

A Meta-analysis of Jejunostomy Versus Nasoenteral Tube for Enteral Nutrition Following Esophagectomy.

Is it necessary to routinely perform feeding jejunostomy at the time of esophagectomy? A systematic review and meta-analysis.

Esophagectomy versus definitive chemoradiotherapy as initial treatment for clinical stage I esophageal cancer: a systematic review and meta-analysis.