Postoperative nutritional management after esophagectomy: is TPN the standard of nutritional care?

We investigated the feasibility of early postoperative enteral diet after esophagectomy. Sixteen patients who underwent esophagectomy followed by reconstruction using gastrictube were divided into two groups based on nutritional protocol after surgery: either total parenteral nutrition (TPN) or enteral diet (ENT). TPN patients were nutritionally maintained with only intravenous hyperalimentation. The ENT group was challenged mainly with enteral diet started on day 1. Serum rapid turnover proteins (RTPs; transferrin, prealbumin, retinal-binding protein, and insulin like growth factor-1: IGF-1) were measured two days before (preoperative value) and 3, 5, 7, 10, and 14 days after surgery. The percent value of the four RTPs were decreased at day 3 and gradually recovered. There were no significant differences between the groups according to four RTPs. No major complications due to early enteral diet occurred in ENT patients. We conclude that early enteral diet is nutritionally adequate and might be recommended as standard nutritional care after subtotal esophagectomy.