Efficacy of perioperative immunonutrition in esophageal cancer patients undergoing esophagectomy

Nutrition. 2019 Mar;59:96-102. doi: 10.1016/j.nut.2018.08.006. Epub 2018 Aug 22.

Abstract

Objective: Malnutrition is common in patients with esophageal cancer, resulting in increased postoperative complications and mortality. Although preoperative immunonutrition can significantly reduce the incidence of postoperative infectious complications, its effect in patietns with esophageal cancer undergoing esophagectomy remains unclear. The aim of this study was to investigate the effects of perioperative immunonutritional support on the postoperative course and long-term survival of this group of patients.

Methods: This prospective, randomized study enrolled 40 patients with thoracic esophageal carcinoma undergoing esophagectomy. The patients were divided into two groups and received either immunomodulating enteral nutrition (IMPACT group; IG) or standard enteral nutrition (Ensure group; EG) continuously for 7 d before and 7 d after surgery. Nutritional status, such as rapid turnover protein, postoperative intensive care unit (ICU) length of stay (LOS), postoperative hospital LOS, morbidity, and mortality were investigated prospectively.

Results: There were no significant differences in patient demographic characteristics between the two groups. Levels of retinol-binding protein, as a rapid-turnover protein, were significantly higher on postoperative day (POD) -1, 7, and 14 in the IG compared with the EG group (P = 0.009, P = 0.004, and P = 0.024, respectively). The incidence of postoperative infectious complications and changes to therapeutic antibiotics were significantly lower in the IG group than in the EG group (P = 0.048 and P = 0.012, respectively). There was no significant difference in postoperative ICU or postoperative hospital LOS between the two groups. The 5-y progression-free survival rates in the IG and EG groups were 75% and 64%, respectively (P = 0.188), and the overall survival rates were 68% and 55%, respectively (P = 0.187).

Conclusions: Perioperative immunonutrition may improve early postoperative nutritional status and reduce postoperative infectious complications in patients with esophageal cancer undergoing esophagectomy.

Keywords: Esophageal cancer; Esophagectomy; Immunonutrition; Infective complication; Postoperative nutritional status.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Carcinoma / mortality
  • Carcinoma / therapy*
  • Enteral Nutrition / methods*
  • Esophageal Neoplasms / mortality
  • Esophageal Neoplasms / therapy*
  • Esophagectomy / adverse effects*
  • Female
  • Humans
  • Immunomodulation
  • Incidence
  • Length of Stay
  • Male
  • Middle Aged
  • Nutritional Status
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control*
  • Postoperative Period
  • Preoperative Care / methods*
  • Prospective Studies
  • Treatment Outcome