Aug 2026· Diseases of the esophagus· Vol 39· 0 citations
TL;DR
In conclusion, nutritional supplementation during the 3 months after esophagectomy was associated with preservation of body weight and skeletal muscle mass, with total energy intake showing the strongest effect.
Abstract
Esophageal Cancer: Other
After esophagectomy for esophageal cancer, postoperative weight loss and sarcopenia are common and associated with poor prognosis. Although enteral nutrition is recommended when oral intake is insufficient, the effectiveness and optimal duration of home enteral nutrition remain unclear.
This retrospective single-center study included patients with thoracic esophageal cancer who underwent radical McKeown esophagectomy with gastric tube reconstruction and jejunostomy between March 2023 and December 2024. Patients with recorded body weight data preoperatively and at 3 months postoperatively were eligible. Enteral nutrition (EN) was initiated on postoperative day 1 and continued after discharge at a target of 600 kcal/day for 90 days. Nutritional counseling was provided monthly, and body composition was assessed using bioelectrical impedance analysis. Resting energy expenditure was calculated using the Schofield equation with an activity factor of 1.3. Patients were stratified based on EN/ONS intake (≥600 vs <600 kcal/day), oral intake (≥50% vs <50% of TEE), and total energy intake (≥75% vs <75% of TEE). Changes in body weight and skeletal muscle mass over 90 days were analyzed.
Overall, 16 (41.0%) patients completed the 600 kcal/day target. They experienced significantly less weight loss at 3 months than the non-completion group (−7.6% vs −10.5%, p = 0.03). Oral intake sufficiency (≥ 50% of estimated energy requirements) was associated with a favorable trend in body weight and skeletal muscle mass changes. Achieving ≥ 75% of total energy expenditure was significantly associated with reduced weight (−7.9% vs −19.6%, p = 0.002) and muscle loss (−5.4% vs −12.3%, p = 0.01). In patients with insufficient oral intake, supplementation ≥ 600 kcal/day effectively reduced both weight and muscle loss.
In conclusion, nutritional supplementation during the 3 months after esophagectomy was associated with preservation of body weight and skeletal muscle mass, with total energy intake showing the strongest effect. Supplementation of approximately 600 kcal/day was particularly beneficial for patients with insufficient oral intake. This structured approach incorporating nutritional counseling and BIA may provide a practical benchmark for postoperative nutritional management.
Esophageal Cancer: Other
At our institution, surgical procedures for esophagogastric junction cancer (EGJ) are selected based on tumor location and length of esophageal invasion, choosing either Ivor-Lewis esophagectomy (IL) or proximal gastrectomy (PG). To mitigate postoperative weight loss, all patients receive nutritional support with elemental diet supplementation (300 kcal/day) and structured dietary counseling by a registered dietitian before discharge and at 1, 3, 6, and 12 months postoperatively (POM). Quality of life (QOL) is assessed using the Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37), and results are fed back to patients.
To compare postoperative body weight changes and longitudinal trends in PGSAS-37 scores up to 12 months after IL and PG at our institution. Between January 2019 and December 2024, 81 patients underwent IL or PG for esophageal cancer (E), EGJ cancer (EGJ), or gastric cancer (G) (IL: n=51; PG: n=30). After excluding patients with early recurrence within 12 months and those without completed questionnaires, 45 patients were included in the analysis. Extracted variables included patient characteristics, postoperative complications, anastomotic stricture, duration of elemental diet intake (months), body weight loss rate (BWL, %) at 1, 3, 6, and 12 POM, and longitudinal changes in total and symptom-specific PGSAS-37 scores.
Among 45 eligible patients, 27 underwent IL (E:21, EGJ:6) and 18 underwent PG (EGJ:5, G:13). Median age was 72 in IL and 80 in PG; preoperative BMI was comparable. Neoadjuvant chemotherapy was administered only in IL (n=11). Grade ≥3 complications occurred in 11.1% (IL) and 5.6% (PG), all due to anastomotic leakage. Anastomotic stricture occurred in one patient in each group. Median duration of elemental diet supplementation was longer in IL (4 vs. 1 months). Body weight loss (%) at 1/3/6/12 months was 5.7/8.6/11.4/13.0 in IL and 3.2/7.8/11.1/10.8 in PG. Total PGSAS-37 scores showed similar trends; however, reflux and meal-related distress subscales were generally better in PG. Questionnaire response rates were higher in PG throughout follow-up.
Both procedures demonstrated rapid weight loss within 3 months postoperatively,suggesting that early postoperative reduction in oral intake may play a greater role than procedural differences in determining weight loss patterns. However, IL was associated with greater weight loss at 12 months and tended to show worse symptom-related QOL scores. Despite longer elemental diet supplementation in the IL group, weight loss progressed, indicating that procedure-specific symptoms and functional limitations may influence long-term nutritional outcomes. In conclusion, although early weight loss trajectories were similar between IL and PG, differences emerged in long-term weight loss and QOL indicators at 12 months.
Hideki Sunagawa, Hiroshi Okabe, Yuya Takabe· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer
Esophageal cancer is a common malignancy worldwide, with a five-year survival rate of 5-15%, which may increase to nearly 40% following surgical resection. However, esophagectomy with reconstruction remains a high-risk procedure associated with postoperative organ dysfunction, particularly impaired gastrointestinal function. The safety and benefits of early enteral feeding after esophagectomy remain controversial due to concerns regarding anastomotic healing and delayed gastric emptying, balanced against the potential advantages of preventing intestinal mucosal atrophy and reducing postoperative inflammation. Therefore, this study aimed to investigate the effects of early enteral nutrition on postoperative recovery and inflammatory response following esophagectomy with reconstruction.
This prospective randomized study enrolled 70 patients with esophageal cancer undergoing minimally invasive esophagectomy with reconstruction and jejunostomy. Patients were randomly assigned to an experimental group (n = 35) or a control group (n = 35). In the experimental group, enteral feeding via jejunostomy was initiated within 24 hours postoperatively. In the control group, enteral feeding was initiated after the first postoperative bowel movement according to routine care.
The primary outcome was time to first postoperative bowel movement. Secondary outcomes included postoperative inflammatory and infection-related markers (C-reactive protein, procalcitonin, and neutrophil percentage), length of stay in the intensive care unit, total hospital length of stay, and postoperative complications.
The experimental group demonstrated a significantly shorter time to first postoperative bowel movement compared with the control group (46.95 ± 33.1 vs. 69.12 ± 33.5 hours, p < 0.001). Postoperative C-reactive protein levels were significantly lower in the experimental group (8.24 ± 5.49 vs. 15.0 ± 6.89 mg/dL, p < 0.001). Infection-related markers, including procalcitonin (0.38 ± 0.38 vs. 0.83 ± 1.36 ng/mL, p = 0.043) and neutrophil percentage (84.56 ± 4.20% vs. 87.07 ± 5.20%, p = 0.007), were also significantly reduced.
The length of stay in the intensive care unit was significantly shorter in the experimental group (5.34 ± 4.30 vs. 9.88 ± 11.88 days, p < 0.001), whereas total hospital length of stay did not differ significantly between groups. No significant differences were observed in the incidence of pneumonia or anastomotic leakage.
Compared with conventional postoperative feeding protocols, early enteral feeding improves gastrointestinal functional recovery, reduces inflammatory and infection-related responses, and shortens intensive care unit stay in patients undergoing esophagectomy with reconstruction.
Chia-Yu Li, Jang-Ming Lee, Shuenn-Wen Kuo et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications
Patients recovering from oesophagectomy are at high risk of malnutrition due to altered gastrointestinal anatomy, the need to change dietary habits, and postoperative symptoms including dysphagia and dumping syndrome. FJ placement has traditionally supported postoperative nutrition; however, minimally invasive and robotic surgical techniques have reduced routine FJ use. Specialist oesophago-gastric dietetic input is therefore essential to support recovery, optimise oral intake, and identify patients requiring additional nutritional support. This study evaluates the impact of discontinuing routine FJ placement, focusing on oral nutritional supplement use, delayed requirement for enteral nutrition support, and postoperative weight change following surgery.
A retrospective analysis was conducted of consecutive patients undergoing oesophagectomy at a single centre between October 2023 & June 2025. Patients were grouped according to FJ placement (FJ vs no-FJ). All patients received ongoing support from a specialist oesophago-gastric dietitian throughout recovery. Outcomes included ONS utilisation and tolerance, delayed requirement for ENS following discharge, and median weight change at 3–4 and 12 months postoperatively.
A total of 112 patients were included (54 FJ vs 58 no-FJ). Patients managed without routine FJ demonstrated greater reliance on ONS, with 38% advised to trial ONS compared to 17% in the FJ group. Tolerance was variable, with 20% experiencing poor tolerance, leading to reduced adherence.
In the no-FJ group, 19% required delayed ENS, whereas no patients in the FJ group required new enteral access. Median weight loss at 3–4 months was greater in the no-FJ group (−10.1 kg vs −4.5 kg), and this difference persisted at 12 months (−9.25 kg vs −6.0 kg).
Omission of routine FJ placement following oesophagectomy increases reliance on ONS, although tolerance may be limited, and a subset of patients require delayed ENS. The significant nutritional challenges in this population underscore the importance of specialist dietetic support to guide recovery and escalate care where needed. Greater weight loss observed in patients without FJ highlights the need for careful patient selection and close multidisciplinary follow-up. A selective approach to FJ placement may reduce unnecessary intervention while ensuring adequate nutritional support in higher-risk patients.
BackgroundEarly postoperative energy intake after gastrectomy may be insufficient and may contribute to short-term weight loss, yet whether tolerating an oral diet within a standardized clinical pathway corresponds to adequate intake remains unclear. We examined early postoperative energy intake and its association with weight loss after gastrectomy.MethodsWe retrospectively assessed postoperative energy intake and weight loss in patients with pStage II-III gastric cancer who underwent distal gastrectomy at our hospital between January 2012 and December 2021. Multivariable analysis using multiple regression was performed to evaluate the association between postoperative energy intake and weight loss.ResultsThe median (interquartile range) weight loss was 2.5 (1.00-3.70) kg, corresponding to a reduction of 4.2% (1.9%-6.4%). Median energy intake was 1148 (987-1251) kcal/day, corresponding to 18.9 (15.0-21.9) kcal/kg/day based on body weight. The median oral intake rate was 81.5% (68.80-89.60) during postoperative days (PODs) 3-14 and 90.8% (78.65-98.20) during PODs 7-14. The multivariable analysis identified postoperative energy intake per body weight as a factor associated with weight loss (estimated regression coefficient = -0.18, 95% confidence interval [CI] = -0.27 to -0.09, P < .01). C-Reactive protein (CRP) level was also identified as a factor associated with weight loss (estimated regression coefficient = 0.14, 95% CI = 0.01-0.27, P = .039).DiscussionInsufficient early postoperative energy intake and elevated preoperative CRP were independently associated with weight loss after distal gastrectomy. Despite apparent oral feeding success within a standardized clinical pathway, "hidden underfeeding" persisted-particularly in larger patients-warranting individualized nutritional supplementation strategies.
Kota Taketani, Haruna Furukawa, Takeshi Saijo et al.· The American surgeon· 0 citations
Benign Disease: Iatrogenic Esophageal Disease, Perforation and Postsurgical Complications
Gastroesophageal reflux disease (GERD) after esophagectomy is an important complication that impairs postoperative quality of life (QOL). However, factors associated with the incidence of GERD, particularly the impact of acid-suppressive medication use, remain unclear.
We retrospectively analyzed 106 patients who underwent esophagectomy for esophageal cancer at our institution between January 2013 and December 2022. GERD was defined as the presence of reflux symptoms persisting for more than three months postoperatively or endoscopic findings of GERD graded as Los Angeles classification grade A or higher. The associations between perioperative factors and the development of GERD were evaluated. Multivariable analysis using competing risk regression was used for analysis.
During a median follow-up period of 52.1 months, the 3-year cumulative incidence of GERD was 34.3%. All patients received postoperative acid-suppressive therapy, with a median treatment duration of 33.8 months (0.83–105.7). Sixteen patients discontinued therapy within one year, whereas 90 patients continued therapy for ≥1 year. No significant difference in GERD incidence was observed among medication types. Multivariable analysis demonstrated that discontinuation of acid-suppressive medication within one year after surgery was independently associated with the development of GERD. Sex, age, preoperative body mass index, Brinkman index, postoperative body weight change, anastomotic stricture, and recurrent laryngeal nerve palsy were not significantly associated with GERD.
Continuation of acid-suppressive therapy for at least one year after esophagectomy may help reduce the incidence of postoperative GERD. The optimal duration of acid-suppressive therapy after esophagectomy remains unclear and requires further investigation.
Yoshihisa Numata, Tomoyuki Okumura, T. Miwa et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications
Feeding jejunostomy is frequently used as a nutritional adjunct following esophagectomy. Its routine placement remains debated, partially due to concerns regarding morbidity. Introduction of a robotic programme at the authors’ institution prompted evaluation of jejunostomy techniques. This study compared complications associated with Freka and MIC jejunostomies following Ivor Lewis esophagectomy.
All patients undergoing Ivor Lewis esophagectomy between October 2019 and May 2025 were included in this single-centre retrospective study. Patients without jejunostomy placement, with pre-existing jejunostomies, or with unavailable tube-type data were excluded. Feeding jejunostomy–related complications occurring during the index admission or within 90 days postoperatively were recorded. Complications were graded according to the Clavien–Dindo (CD) classification. Overall complication rates, severity distribution, and requirement for return to theatre were compared between Freka and MIC jejunostomy groups using chi-square testing.
Of 341 esophagectomies performed during the study period, 312 patients were analysed (Freka n=157; MIC n=155). Jejunostomy-related complications occurred in 16 Freka (10.2%) and 13 MIC patients (8.4%) (p=0.58). Freka complications comprised 10 CD I–II (6.4%) and 6 CD III (3.8%) events, compared with 10 CD I–II (6.5%) and 3 CD III (1.9%) events in the MIC group (p=0.61). Return to theatre occurred in 1 Freka (0.6%) and 2 MIC patients (1.3%) (p=0.55), all due to small bowel obstruction. Infection was the most common complication (Freka n=8 vs MIC n=6), followed by tube dislodgement (Freka n=3 vs MIC n=3).
Feeding jejunostomy following Ivor Lewis esophagectomy is associated with a low overall complication rate. Freka and MIC jejunostomy tubes demonstrate comparable incidence and severity of complications, with no statistically significant difference in high-grade morbidity or return to theatre. The Freka system represents a feasible option in the robotic setting, however, further prospective evaluation is warranted.
Isabel Miglior, Natawadee Chantima, J. Chmelo et al.· Diseases of the esophagus· 0 citations
