An investigation into the perioperative nutritional status of patients with oesophagogastric carcinoma and the effect of hospital food fortification and supplementary home enteral feeding on nutritional status and nutritional intake

 

Patients who undergo surgery for upper gastrointestinal carcinoma are at high risk of inadequate nutritional intake and deterioration in nutritional status postoperatively. Early postoperative enteral feeding though widely used in this patient population is rarely continued throughout hospitalisation and patients become dependent on hospital food to meet nutritional requirements. The provision of energy dense foods has been found to improve voluntary energy intake and attenuate weight loss in institutionalised elderly patients. The first part of this thesis (study 1) was undertaken to evaluate the effects of energy and protein dense food provision to patients following upper gastrointestinal surgery for carcinoma.

A control group, comprising forty-four consecutive admissions with oesophagogastric carcinoma that underwent upper gastrointestinal surgery and received standard postoperative care, was compared with thirty-eight consecutive admissions that received fortified foods following surgery.

The provision of fortified foods resulted in a significant improvement in individual energy and protein intakes (p<0.003) but no difference was found in energy and protein intake between control and intervention groups. Maximum oral energy and protein intake during hospitalisation did not exceed 60% overall. Gastric and oesophageal carcinoma patients were well nourished preoperatively indicated by a median preoperative weight loss of less than 10% and a body mass index within the normal or overweight range. A large proportion of patients experienced weight loss during hospitalisation and following discharge home with no difference between control and intervention groups. The follow-on to this study (study 2) involved twenty-one consecutive patients who following oesophagogastrectomy for oesophageal carcinoma were discharged home with supplementary enteral feeding. Nutritional intake and nutritional status was compared with matched patients from the previous study who following oesophagogastrectomy were discharged home with dietary advice alone.

This patient group (enteral feeding group) was also found to be well-nourished preoperatively. Total energy and protein intake was significantly higher in the patients receiving supplementary enteral feeding four weeks following discharge (p<0.001 and p<0.011 respectively). Serum albumin levels were also significantly higher four weeks following discharge (p=0.021). The supplementary feeding was not found to affect oral intake. Perioperative weight loss up to four weeks post discharge was less in the enteral feeding group (p=0.04).

The study highlights the difficulties these patients experience with oral intake post operatively despite intensive dietary monitoring, support and food fortification during hospitalisation. It suggests that continued enteral feeding following discharge home may attenuate weight loss and improve nutritional intake. The effect on patient centred outcomes and quality of life warrants further research.