The effect of early oral feeding after subtotal esophagectomy with immediate esophageal reconstruction on the patients’ nutritional status: randomized single-center study.

Background: The efficiency of early oral feeding (EOF) in the postoperative period is well known. Though in the esophagus surgery doctors still prefer another types of nutritional support after esophagectomy (EE) with immediate gastric tube reconstruction. Aims: to improve the results of patients treatment after EE with gastric tube reconstruction by choosing the method of nutritional support and to evaluate nutritional status of the patients with EOF. Materials and methods: weve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. In the postoperative period we evaluated the results of treatment, the frequency and severity of complications, as well as anthropometric and laboratory indicators of the nutritional status before the operation, on 1, 3 and 6 postoperative day (POD). Results: Patients without high risk of malnutrition were randomly divided in 2 groups: main group (n=30) starting EOF on the 1 POD and control group (n=30) that remained nil by mouth and got parenteral feeding within 4 POD. The patients of EOF group had statistically significant earlier gas discharge (2[2;3] POD vs 4[3;6] POD, р = 0,000042) and stool appearance (3[2;4] POD vs 5[4;7] POD, р = 0,000004). There is a tendency of reduction of the duration of postoperative hospitalization in EOF group (8[7;9] POD vs 9[8;9] POD, р=0,13). EOF does not affect on frequency (46,6% vs 53,3%, р=0,66) and character of postoperative complications. After evaluation of the parameters of nutritional status we found statistically significant decrease of prealbumin level on 3 POD in EOF group (0,17 [0,13;0,21] vs 0,2 [0,16;0,34], р=0,03) of due to inability to compensate daily calorie needs in the first days after the operation. At 6 POD prealbumin became the same in both groups. There were no other significant differences between the groups. Conclusions: EOF after EE with immediate gastric tube reconstruction is safe and effective. EOF doesnt increase the frequency of anastomotic insufficiency and other complications.

P-OGC05 The introduction of an Upper Gastrointestinal (UGI) specific menu can reduce the need for routine jejunostomy (JEJ) placement following UGI Cancer resection

Background Despite the fact that early oral feeding (EOF) after the surgical resection of oesophageal and gastric tumours is safe, and is associated with favourable early in-hospital outcomes, sooner return to physiological GI function and hospital discharge, there can still be some reluctance in establishing EOF. Concerns remain around risk of anastomotic leak, pneumonia, Naso-gastric tube (NGT) reinsertion, re-operation, readmissions and mortality. However, when utilising EOF, a reduction in length of stay, earlier removal of NGT and earlier initiation of soft diet can be observed. JEJ placement is beneficial however complications can arise and the optimal nutritional pathway remains debatable. Methods Patient satisfaction surveys were conducted amongst UGI Cancer patients following Cancer resection and analysed pre and post UGI menu development and staff training. Expert UGI Patient volunteers assisted in the UGI menu development through food tastings producing a new menu in collaboration with the catering department. The new menu was launched and an UGI snack box provided to the UGI Enhanced Recovery Unit (ERAS). Oral intake of Diet and Oral Nutritional Support was analysed for calorie and protein content post menu change, ward staff training and specialist UGI dietetic counselling. This was then compared with calculated minimum estimated nutritional requirements. Results Of the ten patients audited pre discharge: Remaining 1 patient achieved 51% of protein requirements, below the aim of 60%. No patient audited required supplementary Enteral feeding via JEJ or Naso-jejunal tube Patient satisfaction surveys were completed prior to catering staff training and menu revision, after the new menu was implemented. The results show a significant improvement in patient satisfaction following UGI menu implementation. Conclusions Specialist UGI RD support, UGI specific menu and Oral Nutritional Support can reduce the need for routine JEJ placement in favour of on an individual patient basis. Collaborative working between UGI Dietitians, Ward staff, Catering staff and Expert patients is required for UGI specific menu development to be effectual. This audit is limited to small numbers due to adapted operational procedures during the pandemic. This audit will be repeated on a larger scale to yield more meaningful data. Future audit will capture data on how many UGI patients went on to require enteral nutritional support with three months of discharge.

Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction

Traditionally patients can remain nil by mouth (NBM) for up to 12 days after oral tumour resection with free flap reconstruction to reduce the risk of flap dehiscence, poor healing and fistulae. The literature reports that patients could on average remain an inpatient for up to 20 days post-surgery. An evaluation of the impact of a defined early oral feeding protocol was undertaken investigating functional outcomes and complications rates. We prospectively reviewed tracheostomy use, length of hospital stay, non-oral feeding status and swallowing function using the Performance Status Scale for Head and Neck Cancer (PSS-HN) within a defined early feeding protocol. Twenty-nine patients underwent surgical resection with free flap reconstruction for advanced primary oral cancer between January 2018 and December 2019. Average age was 59.5 (range 24–88). Tumour sites included oral tongue (n = 10), maxilla (n = 6), mandible (n = 6), floor of mouth (n = 5) and buccal mucosa (n = 2). Median time to decannulation was 7 days (range 3–20 days, n = 11). The majority of patients were able to tolerate at least oral fluids on day 1 post-operatively (86%, n = 25). In addition to oral intake, non-oral feeding was required in 90% (n = 26), the majority of which included a nasogastric tube (NGT) placed intraoperatively 54% (n = 14), others required gastrostomy 46% (n = 12). Median time to nasogastric tube removal was 6 days (range 3–15 days). Median length of hospital stay was 10 days (range 3–51). Mean PSS-Normalcy of Diet (NOD) score at point of hospital discharge was 36.55 (95% CI 30.9–42.2). Flap failure was noted in 3% (n = 1). The adoption of an early oral feeding protocol suggests that there is the potential for a shorter hospital stay and earlier swallowing rehabilitation.

650 POSTOPERATIVE EARLY ORAL FEEDING PROGRAM ACCELERATES THE RECOVERY OF GASTROINTESTINAL FUNCTION IN ESOPHAGEAL CANCER PATIENTS

Although the early oral feeding program (EOF) pasting the esophagectomy has been demonstrated to be valuable in attenuating inflammatory responses and shortening hospital stay without increasing complications, its impacts on gastrointestinal function recovery have not been elegantly investigated. This study aimed to solve these issues. Methods A total of 110 esophageal cancer patients were included after reviewing a prospective database. Patients of EOF group were compared with patients of late oral feeding (LOF) group with respects to the appearance of first flatus and bowel movement after esophagectomy. Perioperative changes in serum gastrointestinal hormones were compared between EOF group and LOF group using variance analysis of repeated measurements. Multivariable logistic regression was conducted to detect risk factors for delayed recovery of gastrointestinal function after esophagectomy. Results Patients of EOF group showed significantly shorter time from the surgery to the appearance of first flatus (2.1 ± 0.8 d vs 3.4 ± 1.2 d, P < 0.001) and bowel movement (3.2 ± 0.9 d vs. 5.5 ± 1.5 d, P < 0.001) than those of LOF group. Patients of EOF showed increased levels of serum gastrin (P = 0.007) and motilin (P = 0.027) but decreased levels of somatostatin (P = 0.004) and cholecystokinin (P = 0.028) than patients of LOF group based on the repeated measurements on postoperative day 1, 3, and 5. Multivariable analysis demonstrated the EOF (vs. LOF) as a protective factor for delayed recovery of gastrointestinal function. Conclusion The postoperative EOF was demonstrated to accelerate the recovery of gastrointestinal function in esophageal cancer patients from the levels of clinical manifestation and hormone secretion. The EOF was anticipated to be highlighted in promoting perioperative managements.

AN ANALYTICAL STUDY TO ASSESS AND COMPARE OUTCOME OF CLIPPING VERSUS SUTURE LIGATION OF THE CYSTIC DUCT IN LAPAROSCOPIC CHOLECYSTECTOMY

Background: The early oral feeding after the laparoscopic total gastrectomy contributes to the enhanced treatment efficiency and improved quality of life of gastric cancer patients. To evaluate the efficiency of early oral feeding after laparoscopic total gastrectomy in gastric cancer patients at the Nghe An General Friendship Hospital. Methods: A retrospective observational study, performed in patients who underwent laparoscopic total gastrectomy from 2014 to 2020. Results: 126 patients were recruited. The mean age was 60.6 ± 11.1 years. The male/female ratio was 2.8/1. 15.9% of patients had the tumor at the one-third upper stomach, 81.7% at the middle of the stomach. 70.6% of patients contracted adenocarcinoma and ductal carcinoma, 24.6% of patients had ring cell carcinoma. The percent of tumor at stages I, II, III were respectively 19.0%, 49.2%, 31.7%. There were 71.4% of cases underwent laparoscopic total gastrectomy and were made the anastomosis by linear staplers. No case presented complications relating to the anastomosis after the surgery. The mean oral feeding time was 4.4 ± 1.9 (2 – 8 days), 27.8% of cases started at the second postoperative date, 8.7% of cases at the third postoperative date, 29.4% of cases from the fourth and fifth date, and 34.1% of cases started from the sixth date and further. The later the oral feeding time was, the slower recovery of the peristalsis was and vice versa (p < 0.05). There was no difference between the feeding time and the complications (p > 0.05). The more early the feeding time was, the shorter duration of antibiotic therapy observed and vice versa (p < 0.05). The more early the feeding time was, the short duration of hospital stay was and vice versa (p < 0.05). Conclusions: The early oral feeding after laparoscopic total gastrectomy was safe and contributed to improving the efficiency of the treatment, the quality of life in gastric cancer patients. Keywords: Early oral feeding, gastric cancer.