A REVIEW OF THE ROLE OF NUTRITION IN ENHANCING RECOVERY IN PATIENTS TREATED WITH A CURATIVE INTENT FOR ESOPHAGEAL CANCER: FOCUS ON THE ERAS PROTOCOL

Abstract

Patients with esophageal cancer have a high prevalence of malnutrition, associated with poor treatment outcomes. An optimum nutrition regime is required right from the diagnosis through survivorship. Enhanced recovery after surgery (ERAS) for esophageal cancer aim to improve surgical outcomes with a multimodality approach of which the nutritional component is vital. Here, we discuss the recommendations and prevailing evidence pertaining to the nutritional components of an ERAS pathway for esophagectomy, both pre and postoperatively. Before surgery optimization of patient’s nutritional status by thorough screening and assessment for nutritional risk and appropriate intervention for those malnourished is critical. Although dietitians are integral in the nutritional care pathway, a multidisciplinary approach is key to improving patient ́s nutritional status. Prehabilitation, a preoperative conditioning combines optimization of nutritional status with exercise, aims to improve physical status before surgery. Preoperative immunonutrition shows promising effects on attenuation of surgery induced oxidative stress and immunosuppression, albeit with limited data in esophagectomy patients. Long periods of preoperative fasting should be avoided and carbohydrate loading with liquids up to two hours before surgery is recommended but with caution in those with dysphagia. Concerning postoperative ERAS components of nutrition, early enteral nutrition support is superior to parenteral nutrition, but no consensus regarding the optimum route of enteral nutrition exists. Early oral feeding shows bene ts for certain outcomes, but other studies on anastomotic leaks, suggest a higher risk for leaks with early oral feeds. In long-term nutritional status, weight loss is a key issue with more risk in those with a higher preoperative body mass index, especially in the rst six months after surgery. Patients face altered eating patterns after surgery owing to nutrition impact symptoms which affect their ability to regain or maintain weight. Weight maintenance and symptom management is thus an important goal concerning long-term nutritional status. Nutrition plays a key role in all clinical phases of the curative treatment for esophageal cancer and the ERAS protocol provides an effective way to improve nutritional recovery in this highly nutritionally compromised group of patients.

Keywords

• nutritional recovery
• rehabilitation
• esophageal neoplasms