Prevalence of malnutrition in upper GI cancer is quite common, from 60-80% and involves many mechanisms. Malnutrition is a risk factor for postoperative complication and also decreases responsiveness to chemotherapy and increases it’s toxicity. In recent years, immunonutrition has been shown to upregulate host immune response and improve nitrogen balance and protein synthesis after surgery.
Enteral nutrition should be used as fist intent as it has higher efficacy, is less expensive and has a lower risk of iatrogenic complication than parenteral nutrition. Parenteral nutrition should only be used when no oral food is allowed or possible. It has been shown to decrease infectious morbidity but has higher potential for iatrogenic complication. In studies where patients were given immunonutrition in preoperative care it has shown that it was beneficial in all patients and that it should only be continued in those that are malnourished in postoperative care if no complications have occurred.
A major complication of esophageal cancer treatment is pulmonary complications. This is significantly reduced with a minimally invasive surgery. Hence, the standard of care for esophageal cancer treatment should involve minimally invasive surgery, perioperative nutritional support, immunonutritiona and ERA program to decrease postoperative complications.