A prospective evaluation of dietary status and symptoms after near-total esophagectomy without gastric emptying procedure

Background: After esophagectomy, the stomach is the most commonly utilized reconstructive conduit. There remains debate among surgeons regarding the r equirements for pyloroplasty/pyloromyotomy following reconstruction. We pre sent a series of patients having undergone near total esophagectomy and rec onstruction with gastric tube without gastric emptying procedure to analyze critically these patients' ability to reestablish a subjectively acceptabl e and nutritionally adequate eating pattern without significant side effect s of early satiety, dumping, or diarrhea. Methods: Between 1991 and 1998, 48 patients underwent esophagectomy utilizi ng this technique and were available for long-term follow-up and nutritiona l assessment. Patient weights were recorded at 2 weeks, 6 months, and 1 yea r and a telephone interview conducted at a mean of 36 months postoperativel y for the evaluation of eating patterns and symptoms. A subgroup of these p atients (32 of 48) completed a 3-day dietary record that was assessed by a certified nutritionist. This patient group included 10 patients (21%) who h ad received perioperative chemoradiotherapy. Results: Dietary intake was characterized as normal or minimally limited in 41 patients (85%); Those who had received perioperative chemoradiotherapy needed no significant increased time to return to a normal dietary baseline (6.1 versus 5.9 months). Mean weight loss prior to surgery was 3 kg. Weigh t loss continued for the first 6 months (mean 10 kg); however, 63% were abl e to gain weight from 6 months to 1 year following surgery (mean 3 kg). Mos t patients were overweight prior to operation (mean 115% of ideal body weig ht) and achieved a new postoperative baseline (mean 104% of ideal bodyweigh t) at 1 year. Patients demonstrated a mean daily caloric intake of 2,179 ki localories per day, which was:98% of recommended according to their ideal b ody weight. Postoperative symptoms of short-term nausea (19%), occasional d ysphagia with certain foods (38%), mild increased stool frequency (15%), an d occasional regurgitation (25%) were noted. Conclusions: Near-total esophagectomy with verticalized gastric tube withou t a gastric emptying procedure is well tolerated and allows a return to sub jectively acceptable and nutritionally appropriate dietary eating pattern w ithout significant associated side effects. (C) 2001 Excerpta Medica, Inc. All rights reserved.