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

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2.	郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 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, 蒋艳华. 联合营养支持疗法对食管癌患者围手术期营养状况改善的效果. 中华胸部外科电子杂志, 2020, 7(2): 94-97.
11.	石汉平, 李薇, 王昆华, 主编. 肿瘤病人营养状况评估操作手册. 北京: 人民卫生出版社, 2013. 3-28.
12.	卢雪峰, 万学红, 主编. 诊断学. 第9版. 北京: 人民卫生出版社, 2018. 351-352.
13.	王丽君, 顾连兵, 蒋大明, 等. 食管癌患者术后肺部感染围手术期的影响因素分析. 中华医学杂志, 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. 打破传统亚专科片段医疗服务模式引进现代老年医学观念. 中华老年医学杂志, 2012, 31(1): 7-9.
17.	邢沫, 王凤玲, 王丹. 我院建立肿瘤多学科诊疗模式的探讨. 中国医院管理, 2015, 35(6): 29-31.
18.	冯丹, 李玲利, 侯晓玲, 等. 多学科营养治疗在老年关节置换患者围手术期的效果评价. 华西医学, 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.	王国强, 陈军, 杨美英, 等. 多模式联合镇痛在人工关节置换围手术期的疗效观察. 生物骨科材料与临床研究, 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.	刘勇恩, 寇瑛琍. 食管癌术后肺部并发症发生的原因及防治进展. 中国胸心血管外科临床杂志, 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.	刘玉芬, 田萌, 梅嵘. 胃癌手术病人不同途径留置胃肠减压效果的比较. 中华护理杂志, 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.	黄维江, 廖志敏, 胡磊, 等. 三切口食管癌术后肺部感染15例治疗经验. 中国胸心血管外科临床杂志, 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.	潘长坤. 早期营养支持与谷氨酰胺、低分子肝素联合治疗老年重症肺炎的临床效果及对患者凝血功能的影响. 医学理论与实践, 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, 邓晓东, 杨元东. 术前营养支持对肠梗阻患者手术预后的影响. 当代医学, 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. 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 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, 蒋艳华. 联合营养支持疗法对食管癌患者围手术期营养状况改善的效果. 中华胸部外科电子杂志, 2020, 7(2): 94-97.
11. 石汉平, 李薇, 王昆华, 主编. 肿瘤病人营养状况评估操作手册. 北京: 人民卫生出版社, 2013. 3-28.
12. 卢雪峰, 万学红, 主编. 诊断学. 第9版. 北京: 人民卫生出版社, 2018. 351-352.
13. 王丽君, 顾连兵, 蒋大明, 等. 食管癌患者术后肺部感染围手术期的影响因素分析. 中华医学杂志, 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. 打破传统亚专科片段医疗服务模式引进现代老年医学观念. 中华老年医学杂志, 2012, 31(1): 7-9.
17. 邢沫, 王凤玲, 王丹. 我院建立肿瘤多学科诊疗模式的探讨. 中国医院管理, 2015, 35(6): 29-31.
18. 冯丹, 李玲利, 侯晓玲, 等. 多学科营养治疗在老年关节置换患者围手术期的效果评价. 华西医学, 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. 王国强, 陈军, 杨美英, 等. 多模式联合镇痛在人工关节置换围手术期的疗效观察. 生物骨科材料与临床研究, 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. 刘勇恩, 寇瑛琍. 食管癌术后肺部并发症发生的原因及防治进展. 中国胸心血管外科临床杂志, 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. 刘玉芬, 田萌, 梅嵘. 胃癌手术病人不同途径留置胃肠减压效果的比较. 中华护理杂志, 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. 黄维江, 廖志敏, 胡磊, 等. 三切口食管癌术后肺部感染15例治疗经验. 中国胸心血管外科临床杂志, 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. 潘长坤. 早期营养支持与谷氨酰胺、低分子肝素联合治疗老年重症肺炎的临床效果及对患者凝血功能的影响. 医学理论与实践, 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, 邓晓东, 杨元东. 术前营养支持对肠梗阻患者手术预后的影响. 当代医学, 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

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