Long-Term Survival Associated with Direct Oral Feeding Following Minimally Invasive Esophagectomy: Results from a Randomized Controlled Trial (NUTRIENT II)

Simple Summary The direct start of oral intake after surgery improves short-term outcomes in patients undergoing minimally invasive esophagectomy. Based on recent insights, improvements in short-term outcomes may also lead to additional benefits in the long term. The current study investigated the overall survival and disease-free survival in patients receiving direct versus delayed oral feeding after minimally invasive esophagectomy in a randomized controlled cohort (NUTRIENT II trial). The current study showed that patients in the direct oral feeding group had improved 3-year overall survival and 5-year disease-free survival compared to standard care. These findings are unexpected and may provide a new target to improve long-term outcomes in this patient group.Abstract Advancements in perioperative care have improved postoperative morbidity and recovery after esophagectomy. The direct start of oral intake can also enhance short-term outcomes following minimally invasive Ivor Lewis esophagectomy (MIE-IL). Subsequently, short-term outcomes may affect long-term survival. This planned sub-study of the NUTRIENT II trial, a multicenter randomized controlled trial, investigated the long-term survival of direct versus delayed oral feeding following MIE-IL. The outcomes included 3- and 5-year overall survival (OS) and disease-free survival (DFS), and the influence of complications and caloric intake on OS. After excluding cases of 90-day mortality, 145 participants were analyzed. Of these, 63 patients (43.4%) received direct oral feeding. At 3 years, OS was significantly better in the direct oral feeding group (p = 0.027), but not at 5 years (p = 0.115). Moreover, 5-year DFS was significantly better in the direct oral feeding group (p = 0.047) and a trend towards improved DFS was shown at 3 years (p = 0.079). Postoperative complications and caloric intake on day 5 did not impact OS. The results of this study show a tendency of improved 3-year OS and 5-year DFS, suggesting a potential long-term survival benefit in patients receiving direct oral feeding after esophagectomy. However, the findings should be further explored in larger future trials.

Automated summary

The direct start of oral intake after minimally invasive esophagectomy can improve short-term and long-term outcomes. Patients in the direct oral feeding group had higher 3-year overall survival and 5-year disease-free survival.