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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Yu X.-B., Lin Q., Qin X., Ruan Z., Zheng J., Zhou J.-H., Zhou Q.-J.
Department of Thoracic Surgery of Shanghai Jiao Tong University, Affiliated First People’s Hospital, Shanghai 200080, China
Objective: This study aims to investigate and evaluate the efficacy and safety of early enteral nutrition (EN) in maintaining and improving the postoperative nutritional status in patients undergoing esophagectomy.
Methods: A randomized, controlled clinical trial was conducted in 120 adult patients with esophageal cancer and undergoing esophagectomy. Patients were randomly divided into two groups receiving either EN (n = 64) or parenteral nutrition (PN) (n = 56) postoperatively. The nutritional intake was isonitrogenic and isocalorie for both groups. Nutritional status was evaluated preoperatively as well as on postoperative day 1 and day 8. Daily nitrogen balance was measured and 7-day cumulative nitrogen balance was calculated. The levels of serum markers including D-(−)-lactate, diamine oxidase (DAO), and endotoxin were determined on 1st, 4th, and 8th postoperative day for analyzing intestinal barrier function. Postoperative infection rate and the incidence of nutrition support-related complications were examined.
Results: (1) The concentrations of serum albumin and prealbumin in patients of EN group were significantly higher than those in PN group and the concentrations of blood glucose, γ-GT, AKP, TB, and DB were significantly lower compared to those in the PN group (p < 0.05). (2) Both daily nitrogen balance and cumulative nitrogen balance of EN group were better than those of PN group since postoperative day 3. (3) The serum levels of D-(−)-lactate, DAO, and endotoxin of EN group were significantly lower than those of PN group on postoperative day 8 (p < 0.01). (4) The incidence of postoperative infections in blood, lung, and intestinal tract in EN group was lower compared to PN group (p < 0.05). (5) No severe complications associated with nutritional support occurred in EN group. The time to flatus passage in EN group was significantly shorter, and the cost of nutritional support was significantly less compared to PN group (p < 0.05).
Conclusion: Postoperative early enteral nutrition was safe and feasible for patients undergoing esophagectomy. Compared to PN, EN more efficiently ameliorated postoperational nutritional status of the patients undergoing esophagectomy, played an important role in restoring intestinal barrier function postoperatively, reduced the incidence of postoperative infection, and decreased the cost of hospital stay.