Influence of home nutritional therapy on body weight in patients with esophageal cancer after surgery: A prospective observational study

The home nutritional management after esophageal cancer surgery, in which period the patients will experience rapid weight loss, is often ignored. Therefore, we evaluated the influence of oral feeding and tube enteral nutrition on patients' nutritional status and complications after discharge, in order to find a better mode of family enteral nutritional support. We conducted a prospective observational study in 16 Chinese esophageal cancer centers and enrolled esophageal cancer patients with curative esophagectomy. The patients were divided into oral feeding group and tube feeding group according to each center’s treatment plan. The primary endpoint is the proportion of patients who have 5% or more weight loss within 1 month after discharge, and the secondary endpoint is the complication and quality of life after discharge. A total of 533 patients were enrolled between Sep, 2017 and Apr, 2020, including 151 in oral feeding group and 382 in tube feeding group. After discharge, 169 patients (31.71%) had weight loss ≥ 5% within 30 days, including 112 patients in oral feeding group and 57 patients in tube feeding group (74.17% vs 14.92%, P＜0.001). Compared with oral feeding group, the 30-day complication (4.71% vs 11.26%, p=0.006) and re-admission rate (3.40% vs 7.95%, p=0.025) as well as 90-day complication (10.21% vs 18.54%, p=0.009) and readmission rate (7.85% vs 15.23%, P=0.010) were lower in tube feeding group. Multivariate analysis showed that tube feeding could delay the postoperative weight loss of esophageal cancer patients after surgery (OR 0.058, 95% CI 0.036-0.093, P<0.001). QoL score QLQ-C30 showed that compared with oral feeding group, patients in tube feeding group were better in general health, function, and symptoms both 30-day and 90-day after discharge.Table: 1243PUnivariate and multivariate analyses for weight loss ≥ 5% within 30 days after dischargeUnivariate analysisMultivariate analysisHR95%CIPHR95%CIPGenderFemale: Male1.5270.916-2.5460.105Age (y)＜70 : ≧700.9360.552-1.5890.807Charlson comorbidity Index score0：1：2：31.2960.919-1.8270.139Neoadjuvant therapyNo: yes0.4660.317-0.6850.0010.976Stages0：I：II：III：IV0.9670.801-1.1660.723Open surgery: Minimally invasive surgery0.5040.321-0.7930.0030.781Clavien-Dindo garding＜grade 3: ≧ grade 32.7631.763-4.3290.0010.059Oral feeding : tube feeding0.0580.036-0.0930.0010.0580.036-0.093<0.001Peking University Cancer Hospital : others3.8572.619-5.6790.0010.440 Open table in a new tab Active tube feeding enteral nutritional support are necessary to maintain the patients’ weight, reduce postoperative complications and improve the QOL.