Unlocking the correct "code" for nutritional care after esophageal cancer surgery

Author: Yun Junru, Second Affiliated Hospital of Air Force Medical University

Reviewer: Lv Feng, deputy chief physician, Second Affiliated Hospital of Air Force Medical University

With the advancement of medical technology, the treatment of esophageal cancer has become more diverse and precise. Despite this, surgery is still the first choice or necessary treatment for many patients. However, a successful operation is only the first step. The postoperative rehabilitation process, especially nutritional care, is also crucial to the patient's full recovery.

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1. What nutritional challenges do you face after esophageal cancer surgery?

Esophageal cancer surgery, especially surgery involving esophageal resection and reconstruction, can have a significant impact on the patient's digestive system. After surgery, patients often experience problems such as dysphagia and gastrointestinal dysfunction, which makes traditional oral feeding impractical or risky. Therefore, how to provide nutritional support scientifically and reasonably becomes the key to promoting patient recovery.

2. How much do you know about nutritional support?

Nutritional support mainly includes two methods: enteral nutrition and parenteral nutrition.

1. Enteral nutrition

Enteral nutrition refers to a nutritional support method that provides the body with various nutrients needed for metabolism through the gastrointestinal tract. There are two main routes: oral and transcatheter, the latter of which includes nasoduodenal nutrition tubes, jejunostomy tubes, etc. For patients after esophageal cancer surgery, early enteral nutrition can not only improve the patient's nutritional status and enhance immune function, but also promote the recovery of intestinal function and reduce the occurrence of postoperative complications.

For patients who cannot eat orally, nasoduodenal feeding tube is an important way to achieve early enteral nutrition. Under the guidance of gastroscopy, one end of the feeding tube is placed in the duodenum, and the other end is fixed to the nose. Liquid diet can be injected into the patient through this tube. However, it is necessary to fix the feeding tube securely to prevent it from falling off, and flush the tube with warm water before and after each feeding to prevent blockage.

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In addition, we must introduce the preparation and infusion of enteral nutrition solution. Enteral nutrition solution is not simple! It is carefully prepared by professional physicians according to the nutritional needs and digestive ability of patients. It usually contains water, fat, protein, vitamins, trace elements, etc. as the main ingredients. However, in order to meet the needs of patients in different situations, the ingredients of enteral nutrition solution are also different. During infusion, the patient should take a semi-recumbent position to reduce the risk of reflux and aspiration.

2. Parenteral Nutrition

Parenteral nutrition, also known as intravenous nutrition, is suitable for patients who cannot tolerate enteral nutrition or whose enteral nutrition cannot meet their metabolic needs. Simply put, it is to directly enter nutrients into the blood through intravenous infusion to meet the basic needs of the body. However, since parenteral nutrition is not ingested through the gastrointestinal tract, long-term parenteral nutrition may cause disuse atrophy of the patient's intestines. Therefore, those who use parenteral nutrition should transition to enteral nutrition as soon as possible.

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3. What are the specific steps of nutritional care after esophageal cancer surgery?

1. 1 to 5 days after surgery: oral intake is strictly prohibited

In the early postoperative period, due to the effects of surgical trauma and anesthesia, the patient's gastrointestinal function has not yet fully recovered. At this time, oral intake is strictly prohibited to avoid increasing the gastrointestinal burden or causing complications.

2. 1-2 days after surgery: Give a small amount of sugar and saline through a jejunal fistula tube or nasoduodenal feeding tube

1 to 2 days after surgery, in order to maintain the patient's basic fluid balance, a small amount of sugar saline can be given through a jejunostomy tube or a nasoduodenal feeding tube, but care must be taken to control the amount and speed of injection to avoid causing discomfort to the patient.

3. 2-8 days after surgery: Increase the amount of enteral nutrition solution day by day

As the patient's gastrointestinal function gradually recovers, the amount of enteral nutrition solution can be gradually increased, but it should be noted that the maximum amount should not exceed 2500 ml, so as not to exceed the patient's intestinal tolerance. At the same time, the patient's nutritional status and digestive response should be closely monitored, and the nutrition plan should be adjusted in time.

4. 7-8 days after surgery: Patients can start to try to eat a small amount of liquid food

After the patient has passed gas from the anus, he or she can try to eat a small amount of liquid food, such as porridge, milk, rice paste, etc. At this time, the principle of eating small meals frequently should be followed to avoid indigestion caused by taking in too much food at one time.

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5. From 11 to 15 days after surgery: patients can start eating semi-liquid food

As the patient recovers further, his diet can gradually transition to a semi-liquid diet, such as porridge, tofu pudding, steamed eggs, soup noodles and other easily digestible foods.

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6. About 4 weeks after surgery: Patients can resume normal diet

About 4 weeks after surgery, the gastrointestinal function of most patients has basically recovered, and the diet can gradually transition from semi-liquid food to normal diet. However, patients should be careful to avoid eating hard and irritating foods to avoid damaging the esophagus or causing discomfort.

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4. What are the precautions for nutritional care after esophageal cancer surgery?

1. Diet

Patients after esophageal cancer surgery should pay attention to a balanced diet and consume more foods rich in protein, vitamins and inorganic salts, such as fish, meat, eggs, milk, tofu, fresh vegetables and fruits.

Since the patient's stomach capacity is reduced and the digestive function is weakened after surgery, the patient should eat small meals frequently and chew slowly. In addition, the patient should avoid eating spicy, greasy, raw, cold, hard, and overheated or overcooled foods to avoid irritating the esophagus and stomach.

2. Work and rest

After esophageal cancer surgery, patients should get enough sleep and avoid staying up late and overwork. If the body allows, patients can follow the doctor's advice to do appropriate activities, such as walking, Tai Chi and other light exercises. Do not lie down immediately after eating. It is recommended to take a proper walk or stand for a while before resting.

3. Psychological adjustment

Patients and their families should maintain an optimistic attitude and actively face the postoperative recovery process.

4. Regular review

After surgery, patients should go to the hospital for regular checkups to fully understand their physical recovery.

In short, nutritional care after esophageal cancer surgery is an indispensable part of the patient's recovery process. Scientific and reasonable nutritional support can effectively improve the patient's nutritional status, enhance immune function, promote the recovery of intestinal function, and reduce the occurrence of postoperative complications. Therefore, patients and their families should fully understand the relevant knowledge and actively cooperate with medical staff in nutritional care, and work together for the patient's early recovery.