Predictive factors for prolonged nutritional support after oesophagogastric cancer resection

INTRODUCTION: There remains great variation in the use of perioperative feeding adjuncts following oesophagogastric cancer resections with unknown clinical benefit. The aim of this study was to examine which preoperative clinicopathological factors were associated with prolonged use of adjuvant nutritional support after oesophagogastric cancer surgery and to evaluate the associated costs. METHODS: A cohort study of 518 patients undergoing oesophagogastric resection and receiving perioperative parenteral nutrition was undertaken. Preoperative clinicopathological characteristics were evaluated using multivariable logistic regression, providing odds ratios (OR) with 95% confidence intervals (CI) and predictive factors for prolonged parenteral nutrition compared using receiver operator characteristic (ROC) analysis. An economic model was developed using complication rates related to parenteral nutrition and 2021 UK National Health Service tariffs. RESULTS: Predictive factors for prolonged parenteral nutrition use included: age >65 vs ≤65 years (OR 1.83, 95% CI 1.22-2.76), >10% preoperative weight loss (OR 2.20, 95% CI 1.03-4.70), open vs minimally invasive surgery (OR 1.64, 95% CI 1.03-2.62) and neck vs abdominal anastomosis (OR 2.54, 95% CI 1.35-4.79). ROC analysis provided an area under the curve of 0.72. The projected annual unit savings were £75,912 if parenteral nutrition was reserved for high-risk patients. CONCLUSIONS: This study identified factors associated with prolonged nutritional support after oesophagogastric surgery. As practice evolves towards minimally invasive surgery and enhanced recovery protocols with low complication rates, short-course adjuvant feeding may not be necessary for patients who progress promptly to appropriate oral intake. A tailored treatment pathway, excluding routine use of perioperative feeding adjuncts for low-risk patients may lead to considerable cost savings.