Does Carbohydrate Loading Improve Outcomes After Esophagectomy?

Preoperative carbohydrate loading is a recognized component of Enhanced Recovery After Surgery (ERAS), which aims to mitigate the adverse metabolic effects of prolonged fasting and enhance patient well-being. Although preoperative carbohydrate loading has been extensively investigated in various surgical populations, data evaluating its application among patients undergoing esophagectomy are limited. This chapter presents a comprehensive review of the literature with respect to preoperative carbohydrate loading as it applies to patients undergoing esophagectomy, discussing its safety, and impact on glycemic profile, surgical stress response, return of gastrointestinal function, postoperative complications, length of stay and patient-reported outcomes. Despite the lack of specific trials in esophagectomy, evidence extrapolated from other surgical cohorts suggests potential benefits in terms of improved patient experience and metabolic profiles. However, caution is advised, particularly in patients with dysphagia or obstructive symptoms who may be at increased risk of pulmonary aspiration. Liberalization of preoperative fasting and provision of carbohydrate-rich drinks among patients with intact swallowing function may be associated with improved patient well-being, however further research is needed to evaluate the impact of such strategies on postoperative outcomes among patients undergoing esophagectomy.