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Updated: Oct 9, 2025

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Early implementation of a perioperative nutrition support pathway for patients undergoing esophagectomy for
Rebecca A Carr1, Caitlin Harrington1, Christina Stella2
1Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Background:
Unintentional weight loss and malnutrition are associated with poorer prognosis in patients with cancer. Risk of cancer-associated malnutrition is highest among patients with esophageal cancer (EC) and has been repeatedly shown to be an independent risk factor for worse survival in these patients. Implementation of nutrition protocols may reduce postoperative weight loss and enhance recovery in these patients.
Methods:
We retrospectively identified all patients who underwent Ivor Lewis esophagectomy for EC from January 2015 to August 2019 from a prospectively collected institutional database. Patients who underwent surgery after the implementation of this protocol (September 2017-August 2019) were compared with patients who underwent resection before protocol implementation (January 2015-July 2017). Patients undergoing surgery during the month of protocol initiation were excluded.
Results:
Of the 404 patients included in our study, 217 were in the preprotocol group, and 187 were in the postprotocol group. Compared with the preprotocol group, there were significant reductions in length of hospital stay (p < 0.001), time to diet initiation (p < 0.001), time to feeding tube removal (p = 0.012), and postoperative weight loss (p = 0.002) in the postprotocol group. There was no significant difference in the incidence of postoperative complications, 30-day readmission, or mortality rates between groups.
Conclusions:
Results of the present study suggest a standardized perioperative nutrition protocol may prevent unintentional weight loss and improve postoperative outcomes in patients with EC undergoing resection.
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