Concurrent chemoradiotherapy combined with enteral nutrition support:a radical treatment strategy for esophageal squamous cell carcinoma patients with malignant istulae

Background: Concurrent chemoradiotherapy(CCRT) significantly increases the survival rate of esophageal squa?mous cell carcinoma(ESCC) patients with malignant fistulae. Recent clinical evidence has shown the benefits of enteral nutrition for malnourished cancer patients. In this study, we aimed to validate that, with the support of enteral nutrition, ESCC patients who develop malignant fistulae might be able to complete CCRT and achieve long?term survival.Methods: We reviewed the medical records of 652 patients with ESCC who received definitive CCRT at Sun Yat?sen University Cancer Center between January 2010 and December 2012. Treatment outcome and toxicity were ret?rospectively evaluated in 40 ESCC patients with malignant fistulae. All the 40 patients were treated with CCRT and evaluated by clinical nutritionists using nutrition risk screening(NRS) before, during, and after treatment. Twenty?two patients received a nasogastric tube, and 18 underwent percutaneous endoscopic gastrostomy feeding. The median energy intake was 2166 kcal/day. Treatment response was evaluated at 3 months after the completion of CCRT.Results: With a median follow?up of 18 months(range, 3–39 months), patients' 1?year overall survival(OS) rate was 62.5%, and the estimated OS time was 25.5 months. Univariate analysis showed that the NRS score(P n NRS score(P se to treatment(P < 0.001) were sig= 0.003), increase i= 0.024), fistula closure(P = 0.011), and responnifi?cantly associated with OS. Multivariate analysis showed that tumor response(P = 0.044) and increase in NRS score(P = 0.044) were independent predictors of OS. Grade 3 vomiting was observed in 8 patients(20.0%), grade 3 neutro?penia was observed in 11 patients(27.5%), and grade 3 cough was observed in 13 patients(32.5%); 2 patients(5.0%) died of massive bleeding during treatment.Conclusions: CCRT combined with enteral nutrition support is effective for ESCC patients with malignant fistulae. Patients have an increased potential to be cured, especially those who experience complete response and have an increase in NRS score. Careful observation and nutrition support are required for patients with advanced T?category ESCC who undergo CCRT.

Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms

BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.