Early oral feeding after subtotal esophagectomy with immediate esophageal reconstruction as a component of ERAS protocol. A prospective randomized study

Abstract

Introduction. Despite increasing trends toward the early initiation of oral feeding after gastrointestinal surgeries, current evidence about feeding patients after esophagectomy (EE) with gastric tube reconstruction has not been convincing. The further research is needed. The present clinical trial aimed to compare the clinical outcomes of early oral feeding (EOF) with late oral feeding following EE with gastric conduit reconstruction. Objectives. To improve the results of treatment of patients after EE with gastric tube reconstruction by choosing the method of nutritional support in the postoperative period. Materials and methods. Forty patients undergoing esophagectomy with gastric conduit reconstruction enrolled in this prospective randomized controlled trial, and were randomly assigned to a group starting EOF on the first postoperative day (POD) and another group that remained nil by mouth and got parenteral feeding until the 5 POD. The clinical and surgical outcomes were compared between the two groups. Results. Comparing the treatment results of both groups, we did not find a statistically significant difference in the number of patients with postoperative complications in the main and control groups. The patients of EOF group had statistically significant earlier gas discharge-2 vs 4 (3-5.5) POD (p = 0.001) and the appearance of stool - 3 (2-3) vs 4 (2-4.5) POD (p = 0.0002). Early activisation and nutrition support, the absence of intestinal paresis allowed us to note a tendency to reduction of the total time of postoperative hospital stay - 7 (6.5-8.5) vs 8 (7-9) POD (p = 0.1). Conclusions. Early oral nutrition in patients who have undergone EE with gastric conduit reconstruction is safe and effective. However, its use in routine practice is possible only if surgical safety is observed and within the framework of a perioperative support program that includes all the components of ERAS protocol.