Long-Term Survival Associated with Direct Oral Feeding Following Minimally Invasive Esophagectomy: Results from a Randomized Controlled Trial (NUTRIENT II)

SIMPLE SUMMARY: The direct start of oral intake after surgery improves short-term outcomes in patients undergoing minimally invasive esophagectomy. Based on recent insights, improvements in short-term outcomes may also lead to additional benefits in the long term. The current study investigated the overall survival and disease-free survival in patients receiving direct versus delayed oral feeding after minimally invasive esophagectomy in a randomized controlled cohort (NUTRIENT II trial). The current study showed that patients in the direct oral feeding group had improved 3-year overall survival and 5-year disease-free survival compared to standard care. These findings are unexpected and may provide a new target to improve long-term outcomes in this patient group. ABSTRACT: 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.