Immunonutrition in the esophagectomy patient: food for thought
Nutritional status is an important factor that can influence the postoperative course in patients undergoing major cancer surgery. For patients with esophageal cancer, concern for malnutrition is especially important as more than 50% of patients present with weight loss at the time of diagnosis (1,2). Optimizing perioperative nutrition has been an important part of many esophagectomy care pathways and protocols. The American Society for Parenteral and Enteral Nutrition (ASPEN) formally recommends that patients undergoing major gastrointestinal surgery who are malnourished or at-risk of becoming malnourished receive perioperative enteral nutrition (3). However, our traditional understanding of the role of nutrition for improving postoperative healing and reducing complications is evolving, especially as more studies are published on the immune-modulating properties of nutrition and its impact on regulating the inflammatory response after major cancer surgery.