391 A Single Centre Review of Postoperative Oral Dietary Progression and Parenteral Nutrition (PN) Usage After Oesophagogastric (OG) Cancer Surgery

Abstract Aim Enhanced recovery (ER) has become the standard of care in OG surgery. Routine artificial nutrition support (ANS) is commonly used to minimise deterioration in nutritional status postoperatively. There is growing interest in a more selective approach to ANS. Early reintroduction of diet would be paramount in patients not receiving routine ANS. This study reviewed compliance with ER pathway for diet progression, and duration of PN usage in one centre. Method Seventy-one patients who underwent elective oesophagectomy (n=64) and total gastrectomy (n=7) between May 2024-May 2025 were included. Data on time to reintroduction of diet, causes of delays and days on PN was collated. Results Twenty-seven percent (n=19) of patients progressed to diet by day 5 in accordance with the ER pathway. Seventy-three percent (n=52) experienced delays, with the median day of diet progression on day 8 (6-141). Postoperative complications were the most common reasons (overall 61.5%; chest/respiratory (n=17), anastomotic leak (n=6), pharyngeal dysphagia (n=5), postoperative delirium (n=3), chyle leak (n=1)). Potentially avoidable factors (water soluble swallow test delay, no clear reason documented) accounted for 38.5% of delays. Seventy patients received PN after surgery, with 57 (81%) discontinuing by day 10. Conclusions The majority of patients did not progress to diet in accordance with the local ER pathway. Whilst most delays were related to clinical reasons, some were potentially avoidable. Education and a quality improvement project could address these factors. Further research is required to evaluate the potential risks and benefits of a selective approach to ANS.