Jejunostomy-Based Early Enteral Feeding After Esophagectomy

Esophageal cancer remains a major gastrointestinal malignancy worldwide. For patients with resectable disease, esophagectomy with reconstruction remains the main curative treatment. Although the overall 5-year survival rate of esophageal cancer has historically been poor, often around 10% to 15%, contemporary surgical series have reported 5-year survival rates approaching 40% or higher in selected patients undergoing resection. Even so, esophagectomy remains a high-risk procedure. Despite advances in minimally invasive techniques and perioperative care pathways, postoperative complications such as pulmonary infection, delayed gastrointestinal recovery, and anastomosis-related complications remain common. Postoperative ileus and systemic inflammatory response can prolong intensive care unit (ICU) and hospital stay, increase health care resource utilization, and add substantially to patient burden. Accordingly, optimizing postoperative recovery has become a major priority in contemporary esophageal surgery.

The intestine is increasingly recognized as a key organ in immune and metabolic regulation. Delayed enteral nutrition may lead to intestinal mucosal atrophy, impaired gut barrier function, and bacterial translocation, thereby exacerbating systemic inflammatory responses. Current critical care and clinical nutrition guidelines generally recommend initiation of enteral nutrition within 24 to 48 hours in hemodynamically stable patients to preserve intestinal integrity and reduce the risk of infection. Enhanced recovery after surgery (ERAS) protocols likewise advocate early enteral nutrition as part of strategies to accelerate postoperative recovery. Although previous studies

have suggested that early enteral nutrition may improve gastrointestinal recovery and reduce infectious complications, its clinical value after esophagectomy with reconstruction has not yet been clearly established. Concerns remain regarding possible adverse effects of early feeding on anastomotic healing, gastric emptying, and postoperative respiratory function, and published findings have varied across clinical settings. In particular, the optimal route of nutritional support, whether oral feeding, nasogastric tube feeding, or jejunostomy feeding, remains uncertain, especially with respect to anastomotic integrity, pulmonary complications, and other perioperative outcomes. These uncertainties continue to support further investigation of early enteral nutrition in patients undergoing esophageal cancer surgery.

Against this background, we conducted a randomized controlled trial in patients undergoing esophagectomy with reconstruction for esophageal cancer to compare 2 postoperative enteral nutrition strategies delivered via jejunostomy: initiation within 24 hours after surgery and initiation after the first postoperative bowel movement under conventional care. The primary objective was to determine whether earlier enteral feeding improved gastrointestinal functional recovery after esophagectomy. We also performed exploratory analyses of perioperative laboratory parameters, postoperative complications, and other indicators of early postoperative recovery.

Inclusion criteria

• Esophagectomy
• Esophagectomy ＆ reconstruction
• Esophagotomy
• Esophageal reconstruction-with gastric tube
• Esophageal reconstruction-with colon
• Esophageal reconstruction with small intestine

Exclusion criteria

• Gastrointestinal perforation
• Postoperative hemorrhage
• Intestinal obstruction
• Shock