Aug 2026· Diseases of the esophagus· Vol 39· 0 citations
TL;DR
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.
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.
In conclusion, nutritional supplementation during the 3 months after esophagectomy was associated with preservation of body weight and skeletal muscle mass, with total energy intake showing the strongest effect.
Kosei Uehara, M. Sakai, K. Kuriyama et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications
Feeding jejunostomy is frequently used as a nutritional adjunct following esophagectomy. Its routine placement remains debated, partially due to concerns regarding morbidity. Introduction of a robotic programme at the authors’ institution prompted evaluation of jejunostomy techniques. This study compared complications associated with Freka and MIC jejunostomies following Ivor Lewis esophagectomy.
All patients undergoing Ivor Lewis esophagectomy between October 2019 and May 2025 were included in this single-centre retrospective study. Patients without jejunostomy placement, with pre-existing jejunostomies, or with unavailable tube-type data were excluded. Feeding jejunostomy–related complications occurring during the index admission or within 90 days postoperatively were recorded. Complications were graded according to the Clavien–Dindo (CD) classification. Overall complication rates, severity distribution, and requirement for return to theatre were compared between Freka and MIC jejunostomy groups using chi-square testing.
Of 341 esophagectomies performed during the study period, 312 patients were analysed (Freka n=157; MIC n=155). Jejunostomy-related complications occurred in 16 Freka (10.2%) and 13 MIC patients (8.4%) (p=0.58). Freka complications comprised 10 CD I–II (6.4%) and 6 CD III (3.8%) events, compared with 10 CD I–II (6.5%) and 3 CD III (1.9%) events in the MIC group (p=0.61). Return to theatre occurred in 1 Freka (0.6%) and 2 MIC patients (1.3%) (p=0.55), all due to small bowel obstruction. Infection was the most common complication (Freka n=8 vs MIC n=6), followed by tube dislodgement (Freka n=3 vs MIC n=3).
Feeding jejunostomy following Ivor Lewis esophagectomy is associated with a low overall complication rate. Freka and MIC jejunostomy tubes demonstrate comparable incidence and severity of complications, with no statistically significant difference in high-grade morbidity or return to theatre. The Freka system represents a feasible option in the robotic setting, however, further prospective evaluation is warranted.
Isabel Miglior, Natawadee Chantima, J. Chmelo et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications
Following the results of the JCOG1409 trial, thoracoscopic esophagectomy has become the standard treatment for esophageal cancer. However, the introduction of robot-assisted esophagectomy is expected to further reduce postoperative complications and potentially improve long-term outcomes.
We retrospectively analyzed 328 consecutive patients who underwent minimally invasive esophagectomy with gastric conduit reconstruction for thoracic esophageal cancer or esophagogastric junction cancer at our institution between January 2017 and September 2025. Patients were divided into two groups: thoracoscopic esophagectomy (Group A) and robot-assisted esophagectomy (Group B). Short-term outcomes were compared between the two groups.
Of the 328 patients, 170 (51.8%) were in Group A and 158 (48.2%) in Group B. There were no significant differences in baseline characteristics, including median age (A vs. B: 69 vs. 70 years) and sex (male/female: 153/17 vs. 137/21). Perioperative factors (A vs. B) showed no significant differences in median operative time (537.5 vs. 548.5 minutes) or median blood loss (148 vs. 131 mL). Postoperative complications were also comparable: pneumonia (CD grade ≥2) occurred in 23 patients (13.5%) vs. 16 patients (10.1%), and anastomotic leakage (CD grade ≥2) occurred in 18 (10.6%) vs. 23 (14.6%) in Groups A and B, respectively. Recurrent laryngeal nerve palsy was significantly less frequent in Group B, both for CD grade ≥1 (18 [10.6%] vs. 7 [4.4%], p=0.036) and CD grade ≥2 (7 [4.1%] vs. 1 [0.6%], p=0.041). The median postoperative hospital stay was 23 days in both groups, with no significant difference.
Robot-assisted esophagectomy may significantly reduce the incidence of recurrent laryngeal nerve palsy. A randomized controlled trial is currently ongoing to further validate these findings and generate robust evidence.
E. Booka, Takahiro Kuroda, Shuhei Yasumoto et al.· Diseases of the esophagus· 0 citations
Background: Esophagectomy, particularly the Ivor Lewis procedure, remains a key surgical approach for esophageal carcinoma but is associated with significant postoperative risks. Feeding jejunostomy (FJ) is frequently used to ensure nutritional support; however, its routine placement is debated due to potential complications and unclear benefits.
Methods: A retrospective comparative cross-sectional study was conducted at a tertiary care center in Dhaka, Bangladesh, from January 2022 to June 2023. Seventy patients with histologically confirmed esophageal cancer undergoing Ivor Lewis esophagectomy were included. Patients were divided into two groups: Group A (n=30) without FJ and Group B (n=40) with FJ. Demographic, clinical, operative, and postoperative data were analyzed using SPSS v25, with a p-value d” 0.05 considered statistically significant.
Results: Baseline characteristics between the two groups were comparable. The operative time was significantly longer in Group B (336.25±40.11 minutes) compared to Group A (296.00±28.11 minutes; p=0.05). There were no significant differences in ICU stay, discharge weight, readmission rate, or mortality. Skin complications were noted exclusively in Group B (13.33%; p=0.04). No significant differences were observed in anastomotic leakage or mortality.
Conclusions: Routine placement of feeding jejunostomy during Ivor Lewis esophagectomy does not appear to significantly enhance postoperative outcomes and may lead to an increased risk of local complications, such as skin infections. Therefore, selective use of FJ based on the patient’s nutritional status, comorbidities, and perioperative risk factors may be a more appropriate approach. Further prospective studies are warranted to validate these findings and guide clinical practice.
Chest Heart J. 2024; 48(1) : 35-41
M. Chowdhury, Md Ataur Rahman, Dashab Hannan et al.· Chest & Heart Journal· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique
Esophageal bypass surgery is a therapeutic approach for patients with unresectable esophageal cancer who cannot eat orally due to esophageal stricture. It is particularly indicated for patients with severe late-stage esophageal stricture after chemoradiotherapy. Esophageal stenting carries relatively high risks of bleeding and perforation. In recent years, esophageal bypass surgery using a Y-shaped gastric tube has been increasingly adopted in clinical practice as a safe technique with fewer complications.
This study retrospectively analyzed the clinical data of 5 patients with advanced esophageal cancer. Among them, 3 patients developed complete esophageal obstruction and were unable to eat orally after tumor progression following systemic chemoradiotherapy or chemo-immunotherapy. One patient developed esophagotracheal fistula during treatment, and another patient developed esophageal fistula with severe impairment of quality of life due to inability to eat orally. Esophageal bypass surgery was performed in these patients to restore oral intake, improve quality of life, and create favorable conditions for subsequent treatment.
Esophageal bypass surgery was successfully completed in all 5 patients with advanced esophageal cancer. Oral feeding was resumed 10–14 days postoperatively. No anastomotic leakage was observed during postoperative follow-up.
Esophageal bypass surgery is safe and feasible for patients with esophageal cancer. It can significantly improve patients’ quality of life and create favorable conditions for further treatment.
Lin Chen, Weiming Chen, Jiarong Zhang et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications
Symptoms of delayed gastric conduit emptying are common in patients with a gastric conduit reconstruction after esophagectomy, but standardized radiologic evaluation is missing. We aim to describe the pattern of gastric conduit emptying by functional upper gastrointestinal contrast series, and to determine whether Barium or water soluble contrast is more suitable.
The study was approved by the Karolinska University Hospital Radiation Protection Committee and Regional Ethics Board of Stockholm. 30 patients were recruited at least 3 months after esophagectomy and filled in the DGCE symptom grading questionnaire developed in an international consensus process, and baseline data was registered. During a second appointment, radiology according to two phases of the radiology study protocol was performed. In the first phase, 2D frontal images were taken before, 2, 5, 10 and 20 minutes after swallowing 100 ml of water-soluble contrast fluid and at 30 minutes a low-radiation-dose computerized tomography was performed to better quantify possibly remaining contrast fluid. The second phase was performed in same manner using 100 ml of barium contrast. Two radiologists analyzed the images according to a pre-defined protocol, evaluating pillar length and area development as indicators of conduit emptying. Other factors evaluated were difficulty of evaluation, conduit form and risks
Thirty cases accepted to participate in the study, mean age was 68 years (range 52-83), 9 (30%) were female, mean ASA-score was 2,4 (range 2-3) and mean Charlson Comorbidity Index was 3 (range 1-8). All underwent water soluble contrast evaluation, but 5 were not evaluated with barium, due to: 1) large residual food content, 2) anastomotic leakage, 3) pulmonary embolism, 4) aspiration of water-soluble contrast and 5) consent withdrawal. In all cases of evaluation by Barium contrast it was possible to measure contrast pillar and contrast area, but in 5 cases of evaluation by water soluble contrast, poorly definable borders made measurement impossible. Subjectively the radiologists considered barium more trustworthy in 18 cases and easier to measure in 17 cases of the 25 cases available for comparison and the rest of the cases were considered equivalent. Area was considered less demanding than pillar length. Further results will be presented
Due to lack of standardization of functional radiology for individuals with a gastric conduit, methods of objective evaluation are lacking. This is the first study to attempt to describe the emptying function of the gastric conduit in 30 unselected individuals by contrast follow. Preliminary results indicate that area measurement and Barium contrast may be preferrable, but safety measures need to be taken, and the results need to be studied further in a multy-center study.
J. Hultkrantz, M. Konradsson, M. Andersson et al.· Diseases of the esophagus· 0 citations
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