Advancements in perioperative care have improved postoperative morbidity and recovery after esophagectomy. The direct start of oral intake can also enhance short-term outcomes following minimally invasive Ivor Lewis esophagectomy (MIE-IL). Subsequently, short-term outcomes may affect long-term survival. This planned sub-study of the NUTRIENT II trial, a multicenter randomized controlled trial, investigated the long-term survival of direct versus delayed oral feeding following MIE-IL. The outcomes included 3- and 5-year overall survival (OS) and disease-free survival (DFS), and the influence of complications and caloric intake on OS. After excluding cases of 90-day mortality, 145 participants were analyzed. Of these, 63 patients (43.4%) received direct oral feeding. At 3 years, OS was significantly better in the direct oral feeding group (p= 0.027), but not at 5 years (p= 0.115). Moreover, 5-year DFS was significantly better in the direct oral feeding group (p= 0.047) and a trend towards improved DFS was shown at 3 years (p= 0.079). Postoperative complications and caloric intake on day 5 did not impact OS. The results of this study show a tendency of improved 3-year OS and 5-year DFS, suggesting a potential long-term survival benefit in patients receiving direct oral feeding after esophagectomy. However, the findings should be further explored in larger future trials.
围手术期护理的进步改善了食管切除术后并发症发生率及康复情况。直接开始经口进食亦可提升微创艾弗·刘易斯食管切除术后的短期预后。短期预后可能进一步影响长期生存。本研究作为NUTRIENT II试验（一项多中心随机对照试验）的预设亚组分析，旨在探讨微创艾弗·刘易斯食管切除术后直接经口进食与延迟经口进食对患者长期生存的影响。研究终点包括3年及5年总生存期、无病生存期，并分析术后并发症及第5日热量摄入对总生存期的影响。排除90天内死亡病例后，共纳入145例患者进行分析，其中63例（43.4%）接受直接经口进食。结果显示：直接进食组3年总生存期显著更优（p=0.027），但5年总生存期无显著差异（p=0.115）；5年无病生存期在直接进食组显著改善（p=0.047），3年无病生存期亦呈现改善趋势（p=0.079）。术后并发症及第5日热量摄入未对总生存期产生显著影响。本研究结果表明直接经口进食可能改善食管切除术后患者3年总生存期与5年无病生存期，提示其具有潜在的长期生存获益，但该结论仍需通过更大规模试验进一步验证。
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