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Supportive Care in Cancer

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01-06-2018 | Original Article

An investigation into the nutritional status of patients receiving an Enhanced Recovery After Surgery (ERAS) protocol versus standard care following Oesophagectomy

Authors: Katie Benton, Iain Thomson, Elisabeth Isenring, B. Mark Smithers, Ekta Agarwal

Published in: Supportive Care in Cancer | Issue 6/2018

Abstract

Purpose

Enhanced Recovery After Surgery (ERAS) protocols have been effectively expanded to various surgical specialities including oesophagectomy. Despite nutrition being a key component, actual nutrition outcomes and specific guidelines are lacking. This cohort comparison study aims to compare nutritional status and adherence during implementation of a standardised post-operative nutritional support protocol, as part of ERAS, compared to those who received usual care.

Methods

Two groups of patients undergoing resection of oesophageal cancer were studied. Group 1 (n = 17) underwent oesophagectomy between Oct 2014 and Nov 2016 during implementation of an ERAS protocol. Patients in group 2 (n = 16) underwent oesophagectomy between Jan 2011 and Dec 2012 prior to the implementation of ERAS. Demographic, nutritional status, dietary intake and adherence data were collected. Ordinal data was analysed using independent t tests, and categorical data using chi-square tests.

Results

There was no significant difference in nutrition status, dietary intake or length of stay following implementation of an ERAS protocol. Malnutrition remained prevalent in both groups at day 42 post surgery (n = 10, 83% usual care; and n = 9, 60% ERAS). A significant difference was demonstrated in adherence with earlier initiation of oral free fluids (p <0.008), transition to soft diet (p <0.004) and continuation of jejunostomy feeds on discharge (p <0.000) for the ERAS group.

Conclusion

A standardised post-operative nutrition protocol, within an ERAS framework, results in earlier transition to oral intake; however, malnutrition remains prevalent post surgery. Further large-scale studies are warranted to examine individualised decision-making regarding nutrition support within an ERAS protocol.

Stavrou EP, Ward R, Pearson S-A (2012) Oesophagectomy rates and post-resection outcomes in patients with cancer of the oesophagus and gastro-oesophageal junction: a population-based study using linked health administrative linked data. BMC Health Serv Res 12(1):384. https://doi.org/10.1186/1472-6963-12-384 CrossRefPubMedPubMedCentral

Baker M, Halliday V, Williams RN, Bowrey DJ (2016) A systematic review of the nutritional consequences of esophagectomy. Clin Nutr 35(5):987–994. https://doi.org/10.1016/j.clnu.2015.08.010 CrossRefPubMed

Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347(21):1662–1669. https://doi.org/10.1056/NEJMoa022343 CrossRefPubMed

van Heijl M, van Lanschot JJ, Blom RL, Bergman JJ, ten Kate FJ, Busch OR, Reitsma JB, Obertop H, van Berge Henegouwen MI (2010) Outcomes of 16 years of oesophageal surgery: low postoperative mortality and improved long-term survival. Nederlands tijdschrift voor geneeskunde 154:A1156PubMed

Capra S, Ferguson M, Ried K (2001) Cancer: impact of nutrition intervention outcome—nutrition issues for patients. Nutrition (Burbank, Los Angeles County, Calif) 17(9):769–772. https://doi.org/10.1016/S0899-9007(01)00632-3 CrossRef

Martin L, Lagergren J, Lindblad M, Rouvelas I, Lagergren P (2007) Malnutrition after oesophageal cancer surgery in Sweden. Br J Surg 94(12):1496–1500. https://doi.org/10.1002/bjs.5881 CrossRefPubMed

Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, MacFie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg 37(2):259–284. https://doi.org/10.1007/s00268-012-1772-0 CrossRefPubMed

Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136(3):842–847. https://doi.org/10.1053/j.gastro.2008.10.030 CrossRefPubMed

Preston SR, Markar SR, Baker CR, Soon Y, Singh S, Low DE (2013) Impact of a multidisciplinary standardized clinical pathway on perioperative outcomes in patients with oesophageal cancer. Br J Surg 100(1):105–112. https://doi.org/10.1002/bjs.8974 CrossRefPubMed

10.

Hammond JS, Humphries S, Simson N, Scrimshaw H, Catton J, Gornall C, Maxwell-Armstrong C (2014) Adherence to enhanced recovery after surgery protocols across a high-volume gastrointestinal surgical service. Dig Surg 31(2):117–122. https://doi.org/10.1159/000362097 CrossRefPubMed

11.

Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND (2014) Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg 259(3):413–431. https://doi.org/10.1097/sla.0000000000000349 CrossRefPubMed

12.

Munitiz V, Martinez-de-Haro LF, Ortiz A, Ruiz-de-Angulo D, Pastor P, Parrilla P (2010) Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy. Br J Surg 97(5):714–718. https://doi.org/10.1002/bjs.6942 CrossRefPubMed

13.

Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH (2006) ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr 25(2):224–244. https://doi.org/10.1016/j.clnu.2006.01.015 CrossRefPubMed

14.

Lewis S, Andersen H, Thomas S (2009) Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg 13(3):569–575. https://doi.org/10.1007/s11605-008-0592-x CrossRefPubMed

15.

Isenring EA, Capra S, Bauer JD (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91(3):447–452. https://doi.org/10.1038/sj.bjc.6601962 CrossRefPubMedPubMedCentral

16.

Isenring E, Zabel R, Bannister M, Brown T, Findlay M, Kiss N, Loeliger J, Johnstone C, Camilleri B, Davidson W, Hill J, Bauer J (2013) Updated evidence-based practice guidelines for the nutritional management of patients receiving radiation therapy and/or chemotherapy. Nutrition Dietetics 70(4):312–324. https://doi.org/10.1111/1747-0080.12013 CrossRef

17.

Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition (Burbank, Los Angeles County, Calif) 12(1 Suppl):S15–S19. https://doi.org/10.1016/0899-9007(96)90011-8 CrossRef

18.

Gupta V (2009) Benefits versus risks: a prospective audit. Feeding jejunostomy during esophagectomy. World J Surg 33(7):1432–1438. https://doi.org/10.1007/s00268-009-0019-1 CrossRefPubMed

19.

Findlay JM, Tustian E, Millo J, Klucniks A, Sgromo B, Marshall RE, Gillies RS, Middleton MR, Maynard ND (2015) The effect of formalizing enhanced recovery after esophagectomy with a protocol. Dis Esophagus 28(6):567–573. https://doi.org/10.1111/dote.12234 CrossRefPubMed

Title: An investigation into the nutritional status of patients receiving an Enhanced Recovery After Surgery (ERAS) protocol versus standard care following Oesophagectomy
Authors: Katie Benton
Iain Thomson
Elisabeth Isenring
B. Mark Smithers
Ekta Agarwal
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 6/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-017-4038-4

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Abstract

Purpose

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