OA01.7. Impact of Early Enteral Feeding on Digestive Function Recovery After Esophagectomy: A Prospective Randomized Study

Abstract

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.