A case of nutritional management and challenges after esophageal cancer surgery

Abstract

Malnutrition and cachexia are common in cancer patients. Malnutrition rates of cancer patients vary according to the location of the tumor. In esophageal cancer, severe cachexia and sarcopenia are seen at the time of diagnosis. The defense of nutritional therapy (NT) against cancer, especially gastrointestinal cancer, is very difficult. NT should start with the diagnosis of the disease. The aim of NT should be to prevent cancer cachexia, related complications, and mortality. In Türkiye, squamous cell esophageal cancer is often seen, especially due to dietary habits (hot drinks, meat-based diet low in vegetables). This is a case report of a 55-year-old male patient who had lots of challenges during the nutritional management after esophageal cancer surgery. The patient’s complaints did not improve after neoadjuvant therapies and minimally invasive esophagectomy (MIE) was performed. Inflammation and fistula were seen after major abdominal surgery. As long as the fistula and drainage were continued, parenteral nutrition (PN) remained the only option for NT allowing the bowel to rest in the presence of a fistula. In case of contraindication to oral or enteral nutrition (EN), PN was started on day 6 of MIE. Since it was thought that oral or EN could not be started for more than 10 days, a central catheter was placed, and the patient was fed with CPN (central parenteral nutrition). After the insertion of a stent and a nasojejunal (NJ) tube, EN combined with CPN could be applied. Because of anastomotic leakage, oral nutrition couldn’t be continued. Short-term peripheral parenteral nutrition (PPN) therapy was continued until the leakage stopped. The patient was discharged with oral and oral nutritional supplements. Two years after the MIE, no significant difference from previous radiological reports was found and there were no problems with oral nutrition.