Parenteral Nutrition as a Strategic Therapeutic Option for Onco-Geriatric Rehabilitation After Total Gastrectomy and Anastomotic Stenosis Complicated by an Aorto-Esophageal Fistula: A Case Report

Background and Clinical Significance: The nutritional management of onco-geriatric patients after a total gastrectomy remains a challenge, especially in the context of postoperative complications, such as stenosis of the esophagojejunal anastomosis, and in the presence of an aorto-esophageal fistula. Parenteral nutrition is a relevant therapeutic option to maintain nutritional support and enable rehabilitation when oral and enteral feeding are no longer feasible in this specific clinical context; Case Presentation: We report here the case of a 76-year-old patient who underwent a total gastrectomy for gastric adenocarcinoma with several dilated and stented esophagojejunal anastomoses. During the first postoperative year, the nutritional adaptation facilitated rehabilitation and helped him recover well. However, the occurrence of an aorto-esophageal fistula and its treatment with thoracic endovascular aortic repair (TEVAR) made oral and enteral feeding impossible. This was associated with persistent asthenia, physical deconditioning, sarcopenia, weight loss, exercise intolerance, and increased dependence for activities of daily living. Although parenteral nutrition allowed for nutritional stability and the beginning of rehabilitation, a suspected nosocomial infection involving the aortic endograft led to his death before his treatment was complete; Conclusions: This case highlights the relevance of parenteral nutrition as a therapeutic option to continue rehabilitation when enteral access is judged unacceptably risky. However, the risk of infectious complications in the context of malnutrition can compromise the prognosis, and any suspicion of infection involving prosthetic material should be documented microbiologically as completely as possible whenever compatible with the patient’s care objectives. Onco-geriatric assessment to manage older patients with esophagogastric cancer is recommended.