Advances in perioperative nutritional management for patients with esophageal cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Zuyu , YANG Bo , NIU Rong , XUE Jijun , CHEN Jian , LI Dong , ZHAO Wentao , HAN Wenfeng ,  BAI Yue

Department of Thoracic Surgery, Sun Yat-sen University Cancer Center Gansu Hospital, Lanzhou, 730050, P. R. China;

Corresponding author：

BAI Yue, Email: surrealby@163.com

Keywords：

Esophageal cancer; perioperative period; nutritional support; mechanism

DOI：

10.7507/1007-4848.202504010

Video：

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Abstract Full text Figures/Tables Video References Cited by

Esophageal cancer is a prevalent malignant tumor of the digestive tract in China, and radical surgery remains the cornerstone of its comprehensive treatment. However, multifactorial challenges such as postoperative gastrointestinal tract reconstruction, traumatic stress, and tumor-related metabolic disturbances render esophageal cancer patients highly susceptible to malnutrition. Perioperative nutritional support therapy plays a crucial role in enhancing surgical safety, improving clinical outcomes, and elevating patients' quality of life by regulating metabolic homeostasis, preserving organ function, and optimizing the immune microenvironment. This article reviews the mechanisms underlying malnutrition in esophageal cancer, methods for nutritional status assessment, and precision intervention pathways based on multi-omics evaluations. The aim is to strengthen clinicians' awareness of standardized perioperative nutritional management for esophageal cancer patients and promote its clinical implementation, thereby facilitating postoperative recovery and improving long-term quality of life.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	李国仁, 戴建华. 我国早期食管癌筛查的研究进展. 中华胸心血管外科杂志, 2021, 37(1): 52-58.Li GR, Dai JH. Research progress in screening of early esophageal cancer in China. Chin J Thorac Cardiovasc Surg, 2021, 37(1): 52-58.
3.	Liu S, Qiao L, Liu Y, et al. Efficacy and safety evaluation of mixed nutrition for postoperative esophageal cancer patients in China: a meta-analysis. Front Oncol, 2024, 14: 1417765.
4.	Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, et al. Perioperative nutritional support: a review of current literature. Nutrients, 2022, 14(8).
5.	Reijneveld EAE, Kooij CD, Dronkers JJ, et al. The course of physical fitness and nutritional status in patients following prehabilitation before esophageal cancer surgery: results from the PRIOR study. Eur J Surg Oncol, 2025, 51(3): 109575.
6.	Bischoff SC, Bager P, Escher J, et al. ESPEN guideline on clinical nutrition in inflammatory bowel disease. Clin Nutr, 2023, 42(3): 352-379.
7.	Chen C, Xu SJ, Zhang ZF, et al. Severe postoperative complications after minimally invasive esophagectomy reduce the long-term prognosis of well-immunonutrition patients with locally advanced esophageal squamous cell carcinoma. Ann Med, 2025, 57(1): 2440622.
8.	LiYa L, XinSheng Z, Xiang H, et al. A cross-sectional survey study on the correlation analysis of nutritional status and intestinal flora in patients with esophageal cancer. Front Nutr, 2024, 11: 1424039.
9.	Oguma J, Ozawa S, Ishiyama K, et al. Clinical significance of sarcopenic dysphagia for patients with esophageal cancer undergoing esophagectomy: a review. Ann Gastroenterol Surg, 2022, 6(6): 738-745.
10.	Konishi T, Komatsu S, Ito S, et al. Usefulness of preoperative clinical pathway for esophageal cancer-preoperative chemotherapy(UDON), minimally invasive mediastinoscopic esophagectomy, and night home enteral nutrition therapy. Gan To Kagaku Ryoho, 2024, 51(13): 1615-1617.
11.	Nomura E. Postoperative functional evaluation of gastrectomy for gastric cancer. Chin J Cancer Res, 2022, 34(6): 567-574.
12.	Kern KA, Norton JA. Cancer cachexia. JPEN J Parenter Enteral Nutr, 1988, 12(3): 286-298.
13.	Rochoń J, Kalinowski P, Szymanek-Majchrzak K, et al. Role of gut-liver axis and glucagon-like peptide-1 receptor agonists in the treatment of metabolic dysfunction-associated fatty liver disease. World J Gastroenterol, 2024, 30(23): 2964-2980.
14.	Setiawan T, Sari IN, Wijaya YT, et al. Cancer cachexia: molecular mechanisms and treatment strategies. J Hematol Oncol, 2023, 16(1): 54.
15.	Wang P, Liu Q, Chen X, et al. The negative association between skeletal muscle and fat mass wasting caused by oesophagectomy in patients with oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg, 2022, 61(2): 259-266.
16.	Okamoto K, Takamura H, Nagayama T, et al. Usefulness of perioperative nutritional therapy with the glutamine/arginine/calcium β-hydroxy-β-methylbutyrate product in esophageal cancer surgery: a single-center retrospective study. Nutrients, 2024, 16(13).
17.	Wu JX, He Q, Zhou Y, et al. Protective effect and mechanism of lactoferrin combined with hypoxia against high-fat diet induced obesity and non-alcoholic fatty liver disease in mice. Int J Biol Macromol, 2023, 227: 839-850.
18.	Movahed S, Varshoee Tabrizi F, Pahlavani N, et al. Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: a cross-sectional study. Clin Nutr, 2021, 40(6): 4449-4455.
19.	VanderVeen BN, Cardaci TD, Bullard BM, et al. Involvement of the gut microbiota in cancer cachexia. Am J Physiol Cell Physiol, 2024, 327(3): C661-C670.
20.	Hong T, Zou J, He Y, et al. Bisphenol A induced hepatic steatosis by disturbing bile acid metabolism and FXR/TGR5 signaling pathways via remodeling the gut microbiota in CD-1 mice. Sci Total Environ, 2023, 889: 164307.
21.	Thibaut MM, Roumain M, Piron E, et al. The microbiota-derived bile acid taurodeoxycholic acid improves hepatic cholesterol levels in mice with cancer cachexia. Gut Microbes, 2025, 17(1): 2449586.
22.	Rocha IM, Fonseca DC, Torrinhas RSM, et al. Understanding the gut microbiota in cancer cachexia. Curr Opin Clin Nutr Metab Care, 2023, 26(5): 482-489.
23.	Deng P, Durham J, Liu J, et al. Metabolomic, lipidomic, transcriptomic, and metagenomic analyses in mice exposed to PFOS and fed soluble and insoluble dietary fibers. Environ Health Perspect, 2022, 130(11): 117003.
24.	Lv Y, Zhang J, Liu Z, et al. A novel inflammation-based prognostic index for patients with esophageal squamous cell carcinoma: neutrophil lymphocyte ratio/prealbumin ratio. Medicine (Baltimore), 2019, 98(7): e14562.
25.	Xu X, Jing J. Inflammation-related parameter serve as prognostic biomarker in esophageal squamous cell carcinoma. Front Oncol, 2022, 12: 900305.
26.	Yu B, Zhao Y, Teng S, et al. Atractylodin alleviates cancer anorexia-cachexia syndrome by regulating NPY through hypothalamic Sirt1/AMPK axis-induced autophagy. Biochem Biophys Res Commun, 2022, 625: 154-160.
27.	Naito T, Uchino J, Kojima T, et al. A multicenter, open-label, single-arm study of anamorelin (ONO-7643) in patients with cancer cachexia and low body mass index. Cancer, 2022, 128(10): 2025-2035.
28.	Wang Y, Lyu J, Jia H, et al. Clinical utility of the systemic immune-inflammation index for predicting survival in esophageal squamous cell carcinoma after radical radiotherapy. Future Oncol, 2021, 17(20): 2647-2657.
29.	Woodward ZK, Sivasuthan G, Aseervatham R, et al. Impact of preoperative sarcopenia on survival and postoperative outcomes in esophageal cancer patients undergoing esophagectomy: a single-center retrospective study. Cureus, 2025, 17(1): e77521.
30.	Guo J, Si G, Song X, et al. Mediating role of circulating inflammatory proteins in the effect of immune cells on esophageal cancer risk: a Mendelian randomization study. Medicine (Baltimore), 2024, 103(44): e40374.
31.	Luo F, Lu Y, Chen C, et al. Analysis of the risk factors for negative emotions in patients with esophageal cancer during the peri-radiotherapy period and their effects on malnutrition. Int J Gen Med, 2023, 16: 6137-6150.
32.	刘菲菲, 孔雁. 精细化营养支持结合心理行为护理对食管癌术后患者临床康复的影响. 国际护理学杂志, 2024, 43(8): 1465-1468.Liu FF, Kong Y. Effect of refined nutritional support combined with psychological behavioral nursing on clinical recovery of postoperative esophageal cancer patients. Int J Nurs, 2024, 43(8): 1465-1468.
33.	Yao J, Chen X, Meng F, et al. Combined influence of nutritional and inflammatory status and depressive symptoms on mortality among US cancer survivors: findings from the NHANES. Brain Behav Immun, 2024, 115: 109-117.
34.	Chen J, Luo AL, Yang L, et al. Nutrition management by a multidisciplinary team for prevention of nutritional deficits and morbidity following esophagectomy. Braz J Med Biol Res, 2023, 56: e12421.
35.	Wang X, Liu X, Gu Z, et al. Experiences and requirements in nutritional management of patients with esophageal cancer: a systematic review and qualitative meta-synthesis. Support Care Cancer, 2023, 31(12): 633.
36.	Polański J, Dudek K, Mazur G, et al. Effect of nutritional status on psychological functioning and coping in patients with lung cancer. Nutrition, 2023, 109: 111970.
37.	AlleaBelle Gongola M, Reif RJ, Cosgrove PC, et al. Preoperative nutritional counselling in patients undergoing oesophagectomy. J Perioper Pract, 2022, 32(7-8): 183-189.
38.	Kutnik P, Borys M, Nurczyk K, et al. Nutritional responsiveness affects novel neutrophil parameters and reduces in-hospital mortality and costs in elective cancer oesophagectomy - a single center, prospective, observational study. Anaesthesiol Intensive Ther, 2024, 56(1): 77-82.
39.	Fang HC, Farah MH, Shiue SJ, et al. Percutaneous endoscopic gastrostomy prior to esophagectomy for esophageal cancer - a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol, 2022, 16(2): 155-162.
40.	Wang P, Chen X, Liu Q, et al. Good performance of the Global Leadership Initiative on Malnutrition criteria for diagnosing and classifying malnutrition in people with esophageal cancer undergoing esophagectomy. Nutrition, 2021, 91-92: 111420.
41.	Cao Y, Han D, Yang S, et al. Effects of pre-operative enteral immunonutrition for esophageal cancer patients treated with neoadjuvant chemoradiotherapy: protocol for a multicenter randomized controlled trial (point trial, pre-operative immunonutrition therapy). BMC Cancer, 2022, 22(1): 650.
42.	Xu B, Chen H, Zhang Q, et al. Supplemental parenteral nutrition improves patient outcomes after esophageal cancer surgery: a single-center randomized controlled study. Medicine (Baltimore), 2022, 101(47): e31893.
43.	Chen Y, Wang F. Feeding via duodenostomy can reduce intestinal obstruction after radical resection of esophageal cancer better than jejunostomy. J Gastrointest Oncol, 2023, 14(5): 1993-2005.
44.	Pu XS, Bao T, Wang YJ, et al. Laparoscopic jejunostomy during McKeown minimally invasive esophagectomy: a propensity score analysis. Surg Endosc, 2025, 39(3): 1801-1810.
45.	Yun J, Song G, Son M, et al. Global Leadership Initiative on Malnutrition criteria and immunonutritional status predict chemoadherence and survival in stage II/III gastric cancer treated with XELOX chemotherapy. Nutrients, 2024, 16(20): 3468.
46.	Pan S, Cheah L, Bushra R, et al. Impact of early enteral feed composition on the rate of chyle leak post-esophagectomy. Dis Esophagus, 2024, 37(6): doae008.
47.	Sonoi M, Noma K, Tanabe S, et al. Assessing the role of perioperative nutritional education in improving oral intake after oesophagectomy: a retrospective study. Asian Pac J Cancer Prev, 2023, 24(6): 2037-2041.
48.	Zhang G, Sun S, Dong Z, et al. Risk factors for unplanned intensive care unit admission after esophagectomy: a retrospective cohort study of 628 patients with esophageal cancer. Front Oncol, 2024, 14: 1420446.
49.	Wang PY, Chen XK, Liu Q, et al. Application of four nutritional risk indexes in perioperative management for esophageal cancer patients. J Cancer Res Clin Oncol, 2021, 147(10): 3099-3111.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 李国仁, 戴建华. 我国早期食管癌筛查的研究进展. 中华胸心血管外科杂志, 2021, 37(1): 52-58.Li GR, Dai JH. Research progress in screening of early esophageal cancer in China. Chin J Thorac Cardiovasc Surg, 2021, 37(1): 52-58.
3. Liu S, Qiao L, Liu Y, et al. Efficacy and safety evaluation of mixed nutrition for postoperative esophageal cancer patients in China: a meta-analysis. Front Oncol, 2024, 14: 1417765.
4. Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, et al. Perioperative nutritional support: a review of current literature. Nutrients, 2022, 14(8).
5. Reijneveld EAE, Kooij CD, Dronkers JJ, et al. The course of physical fitness and nutritional status in patients following prehabilitation before esophageal cancer surgery: results from the PRIOR study. Eur J Surg Oncol, 2025, 51(3): 109575.
6. Bischoff SC, Bager P, Escher J, et al. ESPEN guideline on clinical nutrition in inflammatory bowel disease. Clin Nutr, 2023, 42(3): 352-379.
7. Chen C, Xu SJ, Zhang ZF, et al. Severe postoperative complications after minimally invasive esophagectomy reduce the long-term prognosis of well-immunonutrition patients with locally advanced esophageal squamous cell carcinoma. Ann Med, 2025, 57(1): 2440622.
8. LiYa L, XinSheng Z, Xiang H, et al. A cross-sectional survey study on the correlation analysis of nutritional status and intestinal flora in patients with esophageal cancer. Front Nutr, 2024, 11: 1424039.
9. Oguma J, Ozawa S, Ishiyama K, et al. Clinical significance of sarcopenic dysphagia for patients with esophageal cancer undergoing esophagectomy: a review. Ann Gastroenterol Surg, 2022, 6(6): 738-745.
10. Konishi T, Komatsu S, Ito S, et al. Usefulness of preoperative clinical pathway for esophageal cancer-preoperative chemotherapy(UDON), minimally invasive mediastinoscopic esophagectomy, and night home enteral nutrition therapy. Gan To Kagaku Ryoho, 2024, 51(13): 1615-1617.
11. Nomura E. Postoperative functional evaluation of gastrectomy for gastric cancer. Chin J Cancer Res, 2022, 34(6): 567-574.
12. Kern KA, Norton JA. Cancer cachexia. JPEN J Parenter Enteral Nutr, 1988, 12(3): 286-298.
13. Rochoń J, Kalinowski P, Szymanek-Majchrzak K, et al. Role of gut-liver axis and glucagon-like peptide-1 receptor agonists in the treatment of metabolic dysfunction-associated fatty liver disease. World J Gastroenterol, 2024, 30(23): 2964-2980.
14. Setiawan T, Sari IN, Wijaya YT, et al. Cancer cachexia: molecular mechanisms and treatment strategies. J Hematol Oncol, 2023, 16(1): 54.
15. Wang P, Liu Q, Chen X, et al. The negative association between skeletal muscle and fat mass wasting caused by oesophagectomy in patients with oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg, 2022, 61(2): 259-266.
16. Okamoto K, Takamura H, Nagayama T, et al. Usefulness of perioperative nutritional therapy with the glutamine/arginine/calcium β-hydroxy-β-methylbutyrate product in esophageal cancer surgery: a single-center retrospective study. Nutrients, 2024, 16(13).
17. Wu JX, He Q, Zhou Y, et al. Protective effect and mechanism of lactoferrin combined with hypoxia against high-fat diet induced obesity and non-alcoholic fatty liver disease in mice. Int J Biol Macromol, 2023, 227: 839-850.
18. Movahed S, Varshoee Tabrizi F, Pahlavani N, et al. Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: a cross-sectional study. Clin Nutr, 2021, 40(6): 4449-4455.
19. VanderVeen BN, Cardaci TD, Bullard BM, et al. Involvement of the gut microbiota in cancer cachexia. Am J Physiol Cell Physiol, 2024, 327(3): C661-C670.
20. Hong T, Zou J, He Y, et al. Bisphenol A induced hepatic steatosis by disturbing bile acid metabolism and FXR/TGR5 signaling pathways via remodeling the gut microbiota in CD-1 mice. Sci Total Environ, 2023, 889: 164307.
21. Thibaut MM, Roumain M, Piron E, et al. The microbiota-derived bile acid taurodeoxycholic acid improves hepatic cholesterol levels in mice with cancer cachexia. Gut Microbes, 2025, 17(1): 2449586.
22. Rocha IM, Fonseca DC, Torrinhas RSM, et al. Understanding the gut microbiota in cancer cachexia. Curr Opin Clin Nutr Metab Care, 2023, 26(5): 482-489.
23. Deng P, Durham J, Liu J, et al. Metabolomic, lipidomic, transcriptomic, and metagenomic analyses in mice exposed to PFOS and fed soluble and insoluble dietary fibers. Environ Health Perspect, 2022, 130(11): 117003.
24. Lv Y, Zhang J, Liu Z, et al. A novel inflammation-based prognostic index for patients with esophageal squamous cell carcinoma: neutrophil lymphocyte ratio/prealbumin ratio. Medicine (Baltimore), 2019, 98(7): e14562.
25. Xu X, Jing J. Inflammation-related parameter serve as prognostic biomarker in esophageal squamous cell carcinoma. Front Oncol, 2022, 12: 900305.
26. Yu B, Zhao Y, Teng S, et al. Atractylodin alleviates cancer anorexia-cachexia syndrome by regulating NPY through hypothalamic Sirt1/AMPK axis-induced autophagy. Biochem Biophys Res Commun, 2022, 625: 154-160.
27. Naito T, Uchino J, Kojima T, et al. A multicenter, open-label, single-arm study of anamorelin (ONO-7643) in patients with cancer cachexia and low body mass index. Cancer, 2022, 128(10): 2025-2035.
28. Wang Y, Lyu J, Jia H, et al. Clinical utility of the systemic immune-inflammation index for predicting survival in esophageal squamous cell carcinoma after radical radiotherapy. Future Oncol, 2021, 17(20): 2647-2657.
29. Woodward ZK, Sivasuthan G, Aseervatham R, et al. Impact of preoperative sarcopenia on survival and postoperative outcomes in esophageal cancer patients undergoing esophagectomy: a single-center retrospective study. Cureus, 2025, 17(1): e77521.
30. Guo J, Si G, Song X, et al. Mediating role of circulating inflammatory proteins in the effect of immune cells on esophageal cancer risk: a Mendelian randomization study. Medicine (Baltimore), 2024, 103(44): e40374.
31. Luo F, Lu Y, Chen C, et al. Analysis of the risk factors for negative emotions in patients with esophageal cancer during the peri-radiotherapy period and their effects on malnutrition. Int J Gen Med, 2023, 16: 6137-6150.
32. 刘菲菲, 孔雁. 精细化营养支持结合心理行为护理对食管癌术后患者临床康复的影响. 国际护理学杂志, 2024, 43(8): 1465-1468.Liu FF, Kong Y. Effect of refined nutritional support combined with psychological behavioral nursing on clinical recovery of postoperative esophageal cancer patients. Int J Nurs, 2024, 43(8): 1465-1468.
33. Yao J, Chen X, Meng F, et al. Combined influence of nutritional and inflammatory status and depressive symptoms on mortality among US cancer survivors: findings from the NHANES. Brain Behav Immun, 2024, 115: 109-117.
34. Chen J, Luo AL, Yang L, et al. Nutrition management by a multidisciplinary team for prevention of nutritional deficits and morbidity following esophagectomy. Braz J Med Biol Res, 2023, 56: e12421.
35. Wang X, Liu X, Gu Z, et al. Experiences and requirements in nutritional management of patients with esophageal cancer: a systematic review and qualitative meta-synthesis. Support Care Cancer, 2023, 31(12): 633.
36. Polański J, Dudek K, Mazur G, et al. Effect of nutritional status on psychological functioning and coping in patients with lung cancer. Nutrition, 2023, 109: 111970.
37. AlleaBelle Gongola M, Reif RJ, Cosgrove PC, et al. Preoperative nutritional counselling in patients undergoing oesophagectomy. J Perioper Pract, 2022, 32(7-8): 183-189.
38. Kutnik P, Borys M, Nurczyk K, et al. Nutritional responsiveness affects novel neutrophil parameters and reduces in-hospital mortality and costs in elective cancer oesophagectomy - a single center, prospective, observational study. Anaesthesiol Intensive Ther, 2024, 56(1): 77-82.
39. Fang HC, Farah MH, Shiue SJ, et al. Percutaneous endoscopic gastrostomy prior to esophagectomy for esophageal cancer - a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol, 2022, 16(2): 155-162.
40. Wang P, Chen X, Liu Q, et al. Good performance of the Global Leadership Initiative on Malnutrition criteria for diagnosing and classifying malnutrition in people with esophageal cancer undergoing esophagectomy. Nutrition, 2021, 91-92: 111420.
41. Cao Y, Han D, Yang S, et al. Effects of pre-operative enteral immunonutrition for esophageal cancer patients treated with neoadjuvant chemoradiotherapy: protocol for a multicenter randomized controlled trial (point trial, pre-operative immunonutrition therapy). BMC Cancer, 2022, 22(1): 650.
42. Xu B, Chen H, Zhang Q, et al. Supplemental parenteral nutrition improves patient outcomes after esophageal cancer surgery: a single-center randomized controlled study. Medicine (Baltimore), 2022, 101(47): e31893.
43. Chen Y, Wang F. Feeding via duodenostomy can reduce intestinal obstruction after radical resection of esophageal cancer better than jejunostomy. J Gastrointest Oncol, 2023, 14(5): 1993-2005.
44. Pu XS, Bao T, Wang YJ, et al. Laparoscopic jejunostomy during McKeown minimally invasive esophagectomy: a propensity score analysis. Surg Endosc, 2025, 39(3): 1801-1810.
45. Yun J, Song G, Son M, et al. Global Leadership Initiative on Malnutrition criteria and immunonutritional status predict chemoadherence and survival in stage II/III gastric cancer treated with XELOX chemotherapy. Nutrients, 2024, 16(20): 3468.
46. Pan S, Cheah L, Bushra R, et al. Impact of early enteral feed composition on the rate of chyle leak post-esophagectomy. Dis Esophagus, 2024, 37(6): doae008.
47. Sonoi M, Noma K, Tanabe S, et al. Assessing the role of perioperative nutritional education in improving oral intake after oesophagectomy: a retrospective study. Asian Pac J Cancer Prev, 2023, 24(6): 2037-2041.
48. Zhang G, Sun S, Dong Z, et al. Risk factors for unplanned intensive care unit admission after esophagectomy: a retrospective cohort study of 628 patients with esophageal cancer. Front Oncol, 2024, 14: 1420446.
49. Wang PY, Chen XK, Liu Q, et al. Application of four nutritional risk indexes in perioperative management for esophageal cancer patients. J Cancer Res Clin Oncol, 2021, 147(10): 3099-3111.

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