Early versus late oral feeding regimens following esophagectomy: a propensity score-matched observational cohort

BACKGROUND: The optimal time to resume oral intake after esophagectomy remains debated, with practices varying across centers.

METHODS: This single-center, retrospective cohort study compared early and late oral feeding regimens after esophagectomy. Perioperative care was identical except for the feeding regimen. Early oral feeding began immediately post-surgery, while late oral feeding started on postoperative day 4 after swallow examination, with jejunostomy for early enteral tube feeding. Propensity score matching was used to reduce confounding. The primary outcome was overall survival. Secondary outcomes included complications, need for an alternative feeding route, hospital stay, readmission, and 90-day mortality.

RESULTS: Between May 2017 and October 2023, 406 patients underwent an esophagectomy (312 transthoracic; 94 transhiatal). After matching, 139 patients were included in both the early and late oral feeding groups. Overall complication rates did not significantly differ (84.9% vs. 77.7%; P = 0.124), but the late oral feeding group had less severe complications (48.9% vs. 36.7%; P = 0.039). The late oral feeding group showed lower leakage rates in intrathoracic anastomosis (33.3% vs. 13.3%; P = 0.008), but no differences for cervical anastomosis. The late oral feeding group had a shorter median hospital stay (12 vs. 11 days, P = 0.008). No differences in overall survival rates were found (Kaplan-Meier: P = 0.604, Cox regression: HR: 1.020, 95% CI 0.729-1.427, P = 0.907).

CONCLUSIONS: Early and late oral feeding showed similar survival rates, but late oral feeding was associated with fewer severe complications, lower anastomotic leakage, and shorter hospital stay. Therefore, despite no survival difference, late oral feeding with jejunal feeding may lead to better postoperative outcomes.