Effects of multidisciplinary perioperative nutrition management on nutritional status and postoperative complications in patients with esophageal cancer: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Wei , HU Jiadai , CHEN Juan , ZHU Ying ,  YANG Mei ,  YUAN Yong , ZHENG E

West China School of Nursing, Sichuan University, Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

YANG Mei, Email: yangmei69@126.com; YUAN Yong, Email: dy818@sina.com

Keywords：

Multidisciplinary team; perioperative period; esophageal cancer; nutritional status; complications

DOI：

10.7507/1007-4848.202103075

Video：

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Objective To investige the effects of multidisciplinary perioperative nutrition management on nutrition and postoperative complications of patients with esophageal cancer.Methods A total of 239 patients with esophageal cancer who received elective surgical treatment were included in the study. They were divided into a trial group (120 patients) and a control group (119 patients) according to the random number table method. There were 97 males and 23 females in the trial group with an average age of 63.78±9.13 years, and 94 males and 25 females in the control group with an average age of 64.12±7.91 years. The control group received routine diet management, and the trial group received multidisciplinary perioperative nutrition management. The differences of nutrition and postoperative complications between the two groups were compared.Results The total protein and albumin levels on postoperative days 3 and 7 in the trial group were higher than those in the control group (P<0.05), patients' postoperative anal exhaust time was shorter than that in the control group (P<0.05), the incidence of postoperative gastrointestinal adverse reactions, lung infection, postoperative anastomotic fistula, hypoproteinemia on postoperative days 3 and 7 was lower than that in the control group (P<0.05), and hospitalization cost was lower than that in the control group (P<0.05).Conclusion Multidisciplinary nutrition management can effectively improve the nutrition of patients, promote the rapid recovery of postoperative gastrointestinal function, reduce postoperative complications, and reduce hospitalization costs. It has high clinical reference and promotion value.

Citation： WANG Wei, HU Jiadai, CHEN Juan, ZHU Ying, YANG Mei, YUAN Yong, ZHENG E. Effects of multidisciplinary perioperative nutrition management on nutritional status and postoperative complications in patients with esophageal cancer: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(11): 1299-1304. doi: 10.7507/1007-4848.202103075 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	鄭榮壽, 孫可欣, 張思維, 等. 2015年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2019, 41(1): 19-28.
3.	Filip B, Scarpa M, Cavallin F, et al. Postoperative outcome after oesophagectomy for cancer: Nutritional status is the missing ring in the current prognostic scores. Eur J Surg Oncol, 2015, 41(6): 787-794.
4.	Steenhagen E, van Vulpen JK, van Hillegersberg R, et al. Nutrition in peri-operative esophageal cancer management. Expert Rev Gastroenterol Hepatol, 2017, 11(7): 663-672.
5.	Steenhagen E. Preoperative nutritional optimization of esophageal cancer patients. J Thorac Dis, 2019, 11(Suppl 5): S645-S653.
6.	Bozzetti F, Mariani L, Lo Vullo S, et al. The nutritional risk in oncology: A study of 1, 453 cancer outpatients. Support Care Cancer, 2012, 20(8): 1919-1928.
7.	Heneghan HM, Zaborowski A, Fanning M, et al. Prospective study of malabsorption and malnutrition after esophageal and gastric cancer surgery. Ann Surg, 2015, 262(5): 803-807.
8.	Rietveld SCM, Witvliet-van Nierop JE, Ottens-Oussoren K, et al. The prediction of deterioration of nutritional status during chemoradiation therapy in patients with esophageal cancer. Nutr Cancer, 2018, 70(2): 229-235.
9.	Toyokawa T, Kubo N, Tamura T, et al. The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: Results from a retrospective study. BMC Cancer, 2016, 16(1): 722.
10.	周和玲, 蔣艷華. 聯合營養支持療法對食管癌患者圍手術期營養狀況改善的效果. 中華胸部外科電子雜志, 2020, 7(2): 94-97.
11.	石漢平, 李薇, 王昆華, 主編. 腫瘤病人營養狀況評估操作手冊. 北京: 人民衛生出版社, 2013. 3-28.
12.	盧雪峰, 萬學紅, 主編. 診斷學. 第9版. 北京: 人民衛生出版社, 2018. 351-352.
13.	王麗君, 顧連兵, 蔣大明, 等. 食管癌患者術后肺部感染圍手術期的影響因素分析. 中華醫學雜志, 2012, 92(19): 1310-1313.
14.	Girard E, Messager M, Sauvanet A, et al. Anastomotic leakage after gastrointestinal surgery: Diagnosis and management. J Visc Surg, 2014, 151(6): 441-450.
15.	Department of Heath. Manual for cancer services 2004. London: Department of Health, 2004. 13-14.
16.	Leng Sean X. 打破傳統亞專科片段醫療服務模式引進現代老年醫學觀念. 中華老年醫學雜志, 2012, 31(1): 7-9.
17.	邢沫, 王鳳玲, 王丹. 我院建立腫瘤多學科診療模式的探討. 中國醫院管理, 2015, 35(6): 29-31.
18.	馮丹, 李玲利, 侯曉玲, 等. 多學科營養治療在老年關節置換患者圍手術期的效果評價. 華西醫學, 2017, 32(4): 589-592.
19.	Kobayashi K, Koyama Y, Kosugi S, et al. Is early enteral nutrition better for postoperative course in esophageal cancer patients? Nutrients, 2013, 5(9): 3461-3469.
20.	Cao S, Zhao G, Cui J, et al. Fast-track rehabilitation program and conventional care after esophagectomy: A retrospective controlled cohort study. Support Care Cancer, 2013, 21(3): 707-714.
21.	Fujita T, Daiko H, Nishimura M. Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer. Eur Surg Res, 2012, 48(2): 79-84.
22.	王國強, 陳軍, 楊美英, 等. 多模式聯合鎮痛在人工關節置換圍手術期的療效觀察. 生物骨科材料與臨床研究, 2015, 12(1): 47-50.
23.	Sun H, Li Y, Liu X, et al. Feasibility of "no tube no fasting" therapy in thoracolaparoscopic oesophagectomy for patients with oesophageal cancer. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 898-901.
24.	Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: Techniques, problems and solutions. World J Gastroenterol, 2014, 20(26): 8505-8524.
25.	劉勇恩, 寇瑛琍. 食管癌術后肺部并發癥發生的原因及防治進展. 中國胸心血管外科臨床雜志, 2008, 15(2): 138-142.
26.	Bauer VP. The evidence against prophylactic nasogastric intubation and oral restriction. Clin Colon Rectal Surg, 2013, 26(3): 182-185.
27.	劉玉芬, 田萌, 梅嶸. 胃癌手術病人不同途徑留置胃腸減壓效果的比較. 中華護理雜志, 2008, 43(4): 299-302.
28.	Prabhakaran S, Doraiswamy VA, Nagaraja V, et al. Nasoenteric tube complications. Scand J Surg, 2012, 101(3): 147-155.
29.	黃維江, 廖志敏, 胡磊, 等. 三切口食管癌術后肺部感染15例治療經驗. 中國胸心血管外科臨床雜志, 2012, 19(6): 592.
30.	Sun H, Li Y, Liu X, et al. Impact of an early oral feeding protocol on inflammatory cytokine changes after esophagectomy. Ann Thorac Surg, 2019, 107(3): 912-920.
31.	Willcutts KF, Chung MC, Erenberg CL, et al. Early oral feeding as compared with traditional timing of oral feeding after upper gastrointestinal surgery: A systematic review and meta-analysis. Ann Surg, 2016, 264(1): 54-63.
32.	Ho I, Fan B, Yuen E, et al. A perioperative nutrition protocol shortened the length of hospital stay for upper gastrointestinal cancer patients. Clin Nutr ESPEN, 2020, 40: 688.
33.	潘長坤. 早期營養支持與谷氨酰胺、低分子肝素聯合治療老年重癥肺炎的臨床效果及對患者凝血功能的影響. 醫學理論與實踐, 2019, 32(11): 1686-1687.
34.	Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr, 2017, 36(3): 623-650.
35.	Card DJ, Gorska R, Harrington DJ. Laboratory assessment of vitamin K status. J Clin Pathol, 2020, 73(2): 70-75.
36.	李健, 鄧曉東, 楊元東. 術前營養支持對腸梗阻患者手術預后的影響. 當代醫學, 2019, 25(12): 45-47.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 鄭榮壽, 孫可欣, 張思維, 等. 2015年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2019, 41(1): 19-28.
3. Filip B, Scarpa M, Cavallin F, et al. Postoperative outcome after oesophagectomy for cancer: Nutritional status is the missing ring in the current prognostic scores. Eur J Surg Oncol, 2015, 41(6): 787-794.
4. Steenhagen E, van Vulpen JK, van Hillegersberg R, et al. Nutrition in peri-operative esophageal cancer management. Expert Rev Gastroenterol Hepatol, 2017, 11(7): 663-672.
5. Steenhagen E. Preoperative nutritional optimization of esophageal cancer patients. J Thorac Dis, 2019, 11(Suppl 5): S645-S653.
6. Bozzetti F, Mariani L, Lo Vullo S, et al. The nutritional risk in oncology: A study of 1, 453 cancer outpatients. Support Care Cancer, 2012, 20(8): 1919-1928.
7. Heneghan HM, Zaborowski A, Fanning M, et al. Prospective study of malabsorption and malnutrition after esophageal and gastric cancer surgery. Ann Surg, 2015, 262(5): 803-807.
8. Rietveld SCM, Witvliet-van Nierop JE, Ottens-Oussoren K, et al. The prediction of deterioration of nutritional status during chemoradiation therapy in patients with esophageal cancer. Nutr Cancer, 2018, 70(2): 229-235.
9. Toyokawa T, Kubo N, Tamura T, et al. The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: Results from a retrospective study. BMC Cancer, 2016, 16(1): 722.
10. 周和玲, 蔣艷華. 聯合營養支持療法對食管癌患者圍手術期營養狀況改善的效果. 中華胸部外科電子雜志, 2020, 7(2): 94-97.
11. 石漢平, 李薇, 王昆華, 主編. 腫瘤病人營養狀況評估操作手冊. 北京: 人民衛生出版社, 2013. 3-28.
12. 盧雪峰, 萬學紅, 主編. 診斷學. 第9版. 北京: 人民衛生出版社, 2018. 351-352.
13. 王麗君, 顧連兵, 蔣大明, 等. 食管癌患者術后肺部感染圍手術期的影響因素分析. 中華醫學雜志, 2012, 92(19): 1310-1313.
14. Girard E, Messager M, Sauvanet A, et al. Anastomotic leakage after gastrointestinal surgery: Diagnosis and management. J Visc Surg, 2014, 151(6): 441-450.
15. Department of Heath. Manual for cancer services 2004. London: Department of Health, 2004. 13-14.
16. Leng Sean X. 打破傳統亞專科片段醫療服務模式引進現代老年醫學觀念. 中華老年醫學雜志, 2012, 31(1): 7-9.
17. 邢沫, 王鳳玲, 王丹. 我院建立腫瘤多學科診療模式的探討. 中國醫院管理, 2015, 35(6): 29-31.
18. 馮丹, 李玲利, 侯曉玲, 等. 多學科營養治療在老年關節置換患者圍手術期的效果評價. 華西醫學, 2017, 32(4): 589-592.
19. Kobayashi K, Koyama Y, Kosugi S, et al. Is early enteral nutrition better for postoperative course in esophageal cancer patients? Nutrients, 2013, 5(9): 3461-3469.
20. Cao S, Zhao G, Cui J, et al. Fast-track rehabilitation program and conventional care after esophagectomy: A retrospective controlled cohort study. Support Care Cancer, 2013, 21(3): 707-714.
21. Fujita T, Daiko H, Nishimura M. Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer. Eur Surg Res, 2012, 48(2): 79-84.
22. 王國強, 陳軍, 楊美英, 等. 多模式聯合鎮痛在人工關節置換圍手術期的療效觀察. 生物骨科材料與臨床研究, 2015, 12(1): 47-50.
23. Sun H, Li Y, Liu X, et al. Feasibility of "no tube no fasting" therapy in thoracolaparoscopic oesophagectomy for patients with oesophageal cancer. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 898-901.
24. Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: Techniques, problems and solutions. World J Gastroenterol, 2014, 20(26): 8505-8524.
25. 劉勇恩, 寇瑛琍. 食管癌術后肺部并發癥發生的原因及防治進展. 中國胸心血管外科臨床雜志, 2008, 15(2): 138-142.
26. Bauer VP. The evidence against prophylactic nasogastric intubation and oral restriction. Clin Colon Rectal Surg, 2013, 26(3): 182-185.
27. 劉玉芬, 田萌, 梅嶸. 胃癌手術病人不同途徑留置胃腸減壓效果的比較. 中華護理雜志, 2008, 43(4): 299-302.
28. Prabhakaran S, Doraiswamy VA, Nagaraja V, et al. Nasoenteric tube complications. Scand J Surg, 2012, 101(3): 147-155.
29. 黃維江, 廖志敏, 胡磊, 等. 三切口食管癌術后肺部感染15例治療經驗. 中國胸心血管外科臨床雜志, 2012, 19(6): 592.
30. Sun H, Li Y, Liu X, et al. Impact of an early oral feeding protocol on inflammatory cytokine changes after esophagectomy. Ann Thorac Surg, 2019, 107(3): 912-920.
31. Willcutts KF, Chung MC, Erenberg CL, et al. Early oral feeding as compared with traditional timing of oral feeding after upper gastrointestinal surgery: A systematic review and meta-analysis. Ann Surg, 2016, 264(1): 54-63.
32. Ho I, Fan B, Yuen E, et al. A perioperative nutrition protocol shortened the length of hospital stay for upper gastrointestinal cancer patients. Clin Nutr ESPEN, 2020, 40: 688.
33. 潘長坤. 早期營養支持與谷氨酰胺、低分子肝素聯合治療老年重癥肺炎的臨床效果及對患者凝血功能的影響. 醫學理論與實踐, 2019, 32(11): 1686-1687.
34. Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr, 2017, 36(3): 623-650.
35. Card DJ, Gorska R, Harrington DJ. Laboratory assessment of vitamin K status. J Clin Pathol, 2020, 73(2): 70-75.
36. 李健, 鄧曉東, 楊元東. 術前營養支持對腸梗阻患者手術預后的影響. 當代醫學, 2019, 25(12): 45-47.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effects of multidisciplinary perioperative nutrition management on nutritional status and postoperative complications in patients with esophageal cancer: A randomized controlled trial

Abstract Full text Figures/Tables Video References Cited by

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