The Comparison Of Different Nutritional Support Programs Of Enhanced Recovery After Surgery For Esophagectomy

Objective:To compare the feasibility and outcomes of different nutritional support programs of enhanced recovery after surgery (ERAS) for esophagectomy.Methods:128 patients with thoracic esophageal and gastroesophageal junction carcinoma were successively selected and received esophagectomy operations. The patients were treated with two different nutritional support programs of ERAS in perioperative period. The patients who completed the nutritional support scheme of ERAS were divided into control group and study group. The nutritional support scheme for the control group consisted of enteral nutrition (EN) by nasojejunal tube, patenteral nutrition (TPN) and early oral diet. The nutritional support scheme for the control study group consisted of TPN and early oral diet. The successful completion rate of the nutritional support pathway and complications were compared between the two different nutritional support programs of ERAS, and reasons of failure completion were analyzed. The clinical observing indexes, changes of blood analysis and serum proteins, and outcomes were compared between groups.Results:116 patients (90.6%) successfully completed the nutritional support scheme of ERAS. There was no significant difference in the successful completion rate of the nutritional support pathway (91.0% vs 90.2%) and complications between two different nutritional support programs of ERAS (P>0.05). The main reasons of failure completion were leaks of esophagogastric anastomosis and gastric tube. The patients were divided into control group (n=60) and study group (n=52) after excluding special comorbidities. Compared with the control groups, the study group significantly shortened chest drain time (6.2±2.6 d vs 6.6±1.5 d) (P<0.05). The levels of serum total protein on the postoperative 4th day and the levels of serum albumin on the postoperative 1th day and on the postoperative 4th day were significantly higher in the study group than in the control group (53±5 g/L vs 51±4 g/L,32±3 g/L vs 31±2 g/L,30±2 g/L vs 28±2g/L) (P<0.05). There were no significant differences in the first flatus time and defecation after operation, the postoperative intravenous fluids time and the postoperative length of stay between groups (P>0.05). There were no significant differences in blood analysis and serum proteins changes, weight changes of admission and discharge and 30-day readmission rate between groups (P>0.05).Conclusion:It is safe and feasible that the nutritional support pattern of ERAS consisting of TPN and early oral diet without postoperative EN by nasojejunal tube. The pathway has a high successful completion rate and don’t increase complications significantly. It is recommended because this nutritional support pattern of ERAS improves the process of recovery, eliminates the discomfort of patients, and lowers treatment expenses as attaining the same efficacy.