Effectiveness of immediate postoperative enteral nutritional support in esophageal carcinoma

Background: Optimal timing of postoperative enteral nutrition followingesophagectomy remains controversial. This study aimed to evaluate the effectiveness ofimmediate postoperative enteral nutritional support on clinical outcomes in patientsundergoing esophagectomy for esophageal carcinoma.Methods: A prospective randomized controlled trial was conducted involving 60patients with esophageal carcinoma undergoing curative esophagectomy. Patients wererandomized to receive either immediate enteral nutrition (IEN) within 24 hours aftersurgery (n=30) or delayed enteral nutrition (DEN) initiated on postoperative day 5(n=30). The primary outcome was the incidence of postoperative infectiouscomplications. Secondary outcomes included nutritional parameters, inflammatorymarkers, recovery milestones, and quality of life.Results: The IEN group demonstrated a significantly lower incidence of overallinfectious complications compared to the DEN group (26.7% vs 56.7%, p=0.018).Pneumonia occurred less frequently in the IEN group (16.7% vs 40.0%, p=0.045). TheIEN group showed improved nutritional parameters, including higher albumin levels onpostoperative day 7 (3.2 ± 0.4 g/dL vs 2.9 ± 0.5 g/dL, p=0.011), reduced inflammatorymarkers (CRP: 82.4 ± 28.6 mg/L vs 128.7 ± 36.2 mg/L on postoperative day 5,p<0.001), faster recovery of gastrointestinal function (time to first flatus: 2.8 ± 0.9 daysvs 3.7 ± 1.2 days, p=0.002), and shorter hospital stay (12.3 days vs 16.8 days,p=0.003). The rates of anastomotic leakage (6.7% vs 16.7%, p=0.228) and feedingintolerance (26.7% vs 20.0%, p=0.542) were similar between groups. Multivariateanalysis identified immediate enteral nutrition as an independent protective factoragainst infectious complications (OR 0.38, p=0.014).Conclusion: Immediate postoperative enteral nutrition following esophagectomysignificantly reduces infectious complications, improves nutritional status, attenuatesinflammatory response, and shortens hospital stay without increasing anastomoticleakage or feeding intolerance. These findings support the routine implementation ofimmediate enteral nutrition after esophagectomy.