Does Early Post-Operative Feeding Improve Outcomes After Esophagectomy?

The timing for restarting oral nutrition after esophagectomy remains controversial and largely dependent on surgeon and institutional preference. As Enhanced Recovery After Surgery (ERAS) becomes popular, there continues to be a stronger push for the resumption of earlier feeding. However, there is a paucity of strong evidence regarding the optimal timing for oral feed resumption. The currently available studies and their findings regarding different feeding protocols after esophagectomy are very heterogeneous. However, patients usually optimize their nutritional intake within 1 month of surgery regardless of feeding protocol. The early oral feeding (EOF) group, however, has a higher weight loss in the first postoperative month. The data regarding pneumonia and anastomotic leak is very variable making definite conclusions difficult. Length of stay is generally shorter in the EOF group but if complications are encountered, it is shorter in the delayed oral feeding group. The quality of evidence that is available in the current literature is moderate at best, making the recommendations weak and conditional. In general, there is a trend towards favoring early oral feeding over naso-enteric feeding, jejunostomy feeding, and parenteral nutrition for the immediate postoperative period in the absence of other complications.