Long-Term Insufficiency of Oral Intake after Esophagectomy: Who Needs Intense Nutritional Support after Esophagectomy?

Abstract

<b><i>Background:</i></b> Patients with esophageal cancer are at a high risk of malnutrition after esophagectomy, and nutritional support may at times be required for several months following surgery. In this study, we aimed to clarify the clinical features and preoperative risk factors of patients with long-term insufficiency of oral intake after esophagectomy by evaluating the duration of feeding enterostomy placement. <b><i>Methods:</i></b> A total of 306 patients who underwent esophagectomy, reconstruction with gastric conduit, and feeding enterostomy creation were retrospectively reviewed. We analyzed the clinical features and preoperative risk factors for long-term placement of feeding enterostomy. <b><i>Results:</i></b> The feeding enterostomy tube was removed less than 90 days after esophagectomy in 234 patients (76.5%) (short group), whereas 72 patients still needed enteral nutrition after 90 days (23.5%; long group). Although severe malnutrition was observed more frequently in the long group compared with the short group (<i>p</i> = 0.021), overall survival time was comparable between the groups (<i>p</i> = 0.239). Multivariate analysis revealed that higher age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01–1.07; <i>p</i> = 0.021), poor performance status (OR 2.94; 95% CI, 1.10–7.87; <i>p</i> = 0.032), and lower preoperative body weight (BW) (OR 0.96; 95% CI, 0.94–0.99; <i>p</i> = 0.009) were the independent variables predicting the long-time placement of feeding enterostomy. <b><i>Conclusion:</i></b> Nutritional support via feeding enterostomy for more than 90 days after esophagectomy was required in 23.5% of patients. The elderly, poor performance status, and lower BW were the independent preoperative factors for predicting the long-term placement of feeding enterostomy.