The effects of increased enteral feeding immediately after the esophageal cancer surgery

Abstract

Background: The impact of increased volume was assessed in immediate enteral nutrition (EN), a standard nutritional support after esophageal cancer surgery. Methods: Patients who did not receive any adjuvant therapy were selected from the two groups in the initial randomized control trial (RCT) to compare the parenteral nutrition (PN) and EN after esophageal surgery. They were divided into two groups-a PN group (n = 9) and an EN-1 group (n = 11). In the EN-1 group, EN was started with 500ml/day from the postoperative day (POD) 1 and increased to 1,500ml/day on POD 5. After RCT, 11 patients (EN-2 group) were given EN started immediately after surgery and increased to 1,500ml/day on POD 3. The infusion of plasma was basically avoided in the EN-2 group. Daily water balance, nutritional parameters, and the incidence of complications were compared for the 3 groups. Results: Caloric intake was significantly higher in the EN-2 group compared to other groups until POD 4. Serum glucose in the EN-2 group was significantly elevated but within the tolerable levels on POD 4. On POD 2, the water balance in the EN-2 group was significantly higher than in other groups. In the EN-2 group, the significantly lower plasma use (2 units) caused significantly lower nutritional laboratory parameters compared to other groups early after surgery. The EN-2 group showed significantly lower total bilirubin from POD 2 compared to the PN group, while the EN-1 group showed this after POD 4. The incidence of postoperative complications did not differ between groups. Patients with comparatively frequent defecation were observed only in the EN-2 group. Conclusions: Increased daily volume of immediate EN resulted in stable fluid homeostasis and facilitated safe management without plasma infusion after esophageal cancer surgery. Suppressive effects on hyperbilirubinemia were enhanced with increased EN volume. The current advanced schedule of EN thus appears to be safe, but careful observation and appropriate deceleration based on age or the body surface area may be indicated.