J.Jpn. Surg. Soc.. 111(1): 8-12, 2010

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Feature topic

RECENT CHANGES IN PERIOPERATIVE NUTRITIONAL SUPPORT IN PATIENTS UNDERGOING THORACOSCOPIC ESOPHAGECTOMY

The advent of thoracoscopic esophagectomy (TSE) has enabled early patient recovery in association with changes in perioperative nutritional support. This article reviews recent changes in the perioperative nutritional support for patients undergoing TSE. TSE associated with a laparoscopic procedure facilitates the recovery of gastrointestinal motility and function while decreasing the incidence of vocal cord paralysis and/or difficulties in swallowing due to accurate mediastinal lymph node dissection. Thus, recent trends in perioperative nutritional support have been early oral feeding and perioperative enteral feeding using a disease-specific polymeric immunoenhancing or immunomodulating enteral formula. Although TSE is associated with less surgical invasiveness, nutritional support still plays an important role in perioperative care to prevent postoperative complications and contribute to the early recovery of nutritional status. Moreover, since TSE is now performed to treat advanced esophageal cancer, patients are frequently malnourished preoperatively and therefore in the group at high risk for postoperative complications. The early start of oral feeding after the evaluation of swallowing function, selecting the appropriate route for enteral nutrition, and sufficient calorie intake during the perioperative period are essential to prevent postoperative pulmonary and/or infectious complications and consequently to improve patient quality of life.

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