BACKGROUND
Evaluation of the nutritional status and perioperative support are key components of the enhanced recovery programs in esophageal surgery. Malnutrition is considered as a risk factor for post-operative morbidity, especially anastomotic leakages and respiratory complications. However, its impact within the framework of enhanced recovery protocols (ERPs) after surgical interventions remains insufficiently studied.
OBJECTIVE
To evaluate the impact of preoperative malnutrition on outcomes in patients who underwent esophagoplasty under conditions of ERPs.
MATERIAL AND METHODS
During the period from January 2014 to August 2025, 176 esophageal reconstructions using a gastric tube or large intestine segment with cervical anastomosis formation were performed at the Petrovsky RNCS. Nutritional status of patients was assessed according to the NRS-2002 scale and GLIM criteria (ESPEN 2019). Patients were divided into high (NRS-2002 >3; n=119) and low (NRS-2002 <3; n=57) nutritional risk groups. Overall incidence of post-operative complications development, incidence of post-operative respiratory complications development, anastomotic leakages, duration of hospital stay and mortality were analyzed.
RESULTS
Esophageal strictures were more frequent in the high-risk group patients (56.3% versus 33.3%; p=0.005), whereas neuromuscular disorders predominated in the low-risk group (p<0.001). The median body mass index was significantly lower in the high-risk group (20.3 [18.6; 22.9] kg/m2 versus 22.8 [20.1; 25.0] kg/m2; p=0.006). Preoperative gastrostomy and intraoperative microenterostomy were more frequently performed in patients from the high-risk group (p<0.001 and p=0.043, respectively). The overall incidence of complications was comparable between groups (37 and 40.4%; p=0.854), differences in the incidence of complications according to the Clavien—Dindo classification, incidence of respiratory complications or failure of anastomotic leakage were not identified. In-hospital deaths were not reported.
CONCLUSION
Preoperative malnutrition was not associated with an increase in the overall incidence of surgical and respiratory complications after esophagoplasty in application of ARPs. Perioperative nutritional therapy as part of ERPs allows to reduce the potential adverse impact of malnutrition. This emphasizes the need for standardized evaluation and timely correction of the nutritional status as an essential element of a multidisciplinary approach to managing patients who underwent reconstructive esophageal surgeries.
