Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Table 1 Literature review of comparative trials on oral feeding after esophagectomy

Authors/year	Design	Procedures	n	Diets	POD PO started	Results
Mahmoodzadeh 2015[20]	RCT	Open Ivor-Lewis, gastrectomy	109	EOF vs DOF	1 vs ROBF	Fewer rehospitalizations and decreased ROBF with EOF
Sun 2015[22]	RCT	MIE McKeown	68	EOF vs DJF	1 vs 7	Faster gastric emptying, ROBF with EOF
Lassen 2008[19]	RCT	Gastrectomy, pancreatectomy, hepatectomy, esophagectomy	447	EOF vs DJF	1 vs 6	No difference in morbidity between EOF, DJF
Giacopuzzi 2017[50]	Prospective cohort	Open or MIE Ivor-Lewis, McKeown	52	ETF vs DTF	1 vs 6	Earlier mobilization and removal of drains with ETF pathway
Weijs 2015[25]	Prospective cohort	MIE Ivor-Lewis	100	EJF, ETF vs DJF, DTF	0 vs 4-7	No difference in complications
Lopes 2018[21]	Retrospective	Open esophagectomy, gastrectomy	161	EOF vs DJF	2 vs 5-7	No difference in complications
Speicher 2018[30]	Retrospective	Open transhiatal	203	EOF vs DJF	3 vs 15	Decreased cervical leak rate with DJF
Eberhard 2017[28]	Retrospective	Open or MIE Ivor-Lewis	359	ETF vs DTF	2 vs 7	Fewer severe complications and leaks with DTF
Bolton 2014[29]	Retrospective	Open or MIE transhiatal	120	EJF vs DJF	7 vs 12	Decreased cervical leak rate with DJF

MIE: Minimally invasive esophagectomy; EOF: Early oral feeding alone; ETF: Early oral feeding with supplemental total parenteral nutrition; EJF: Early oral feeding with supplemental tube feeding; DOF: Delayed oral feeding alone; DTF: Delayed oral feeding with supplemental total parenteral nutrition; DJF: Delayed oral feeding with supplemental tube feeding; TPN: Total parenteral nutrition; RCT: Randomized controlled trial; ROBF: Return of bowel function.

Table 2 Recommended indications for jejunostomy tube placement during esophagectomy

Preoperatively Identified

Dysphagia unrelated to esophageal disease

Elderly

Frailty

High risk for pulmonary complications (i.e., active smoker, preoperative comorbidity)

Preoperative malnutrition

Severe preoperative comorbidity (COPD, renal failure, cirrhosis)

Vocal cord palsy

Intraoperatively Identified

Conversion to open procedure

Intraoperative hemodynamic instability

Questionable esophageal conduit viability

Severe intraoperative complication

Significant operative blood loss

COPD: Chronic obstructive pulmonary disease.