Evaluating the Impact of Enteral Nutrition vs Parenteral Nutrition on Postoperative Outcomes in Esophageal Cancer Patients After Esophagectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Esophageal cancer is a major global health issue, with high incidence, morbidity, and mortality rates. Esophagectomy is a common treatment option; however, it may lead to multiple postoperative complications, which carry significant risks for patients' nutritional and immunological status. While adequate nutritional support has been postulated to play a significant role in reducing postoperative morbidity and mortality in esophageal cancer patients, no consensus has been reached regarding the optimal approach. We have conducted this meta-analysis in an attempt to bridge this gap by assessing the effects of enteral nutrition (EN) versus parenteral nutrition (PN) on postoperative recovery and outcomes in these esophageal cancer patients following esophagectomy. A systematic search of PubMed, Scopus, Web of Science, Scholar, and Cochrane Central Register of Controlled Trials was conducted from inception till March 12, 2025. Our inclusion criteria were: (i) randomized controlled trials; (ii) esophageal cancer patients post-esophagectomy; (iii) EN only compared to PN only; (iv) nutrition started on the first postoperative day with no preoperative EN or PN; and (v) outcomes should include at least one of the following: postoperative nutritional status, immunological status, total postoperative complications, pulmonary complications, anastomotic leakage, postoperative hospital stay, and mortality. The meta-analysis included six studies with a total of 276 patients. Patients who received EN experienced a greater decrease in albumin levels at POD 7 from baseline (MD 0.12, 95% CI [0.00, 0.25], P = 0.05) compared to patients who received PN. EN was linked to a more pronounced decrease in bilirubin levels at POD 7 from baseline compared to PN (MD -0.69, 95% CI [-1.12, -0.26], P = 0.002). Patients who received PN also had a higher incidence of pulmonary complications (RR 0.46, 95% CI [0.21, 1.00], P = 0.05), total postoperative complications (RR 0.73, 95% CI [0.54, 0.98], P = 0.04) and longer hospital stays (MD -3.91, 95% CI [-4.72, -3.09], P<0.00001). No significant differences were found in prealbumin level changes (MD 0, 95% CI [-0.27, 0.27], CRP levels (MD -1.35, 95% CI [-3.34, 0.64], P = 0.18), total protein levels (MD 0.10, 95% CI [-0.04, 0.24], P = 0.15) anastomotic leakage incidence (RR 1.17, 95% CI [0.39, 3.46], P = 0.78) or mortality (RR 1.59, 95% CI [0.22, 11.60], P = 0.64). EN and PN appear to have distinct effects on esophageal cancer patients after esophagectomy. While EN could result in a significant decrease in albumin levels postoperatively when compared to PN, it is associated with better control of bilirubin levels, a lower incidence of pulmonary and total postoperative complications, and shorter hospital stays. The potential benefits of EN may outweigh its risks. The use of EN compared to PN must be evaluated on an individual basis for each patient. Finally, further research is recommended to explore the reasons behind some outcomes such as the lack of significant differences in pre-albumin levels, total protein levels, CRP levels, anastomotic leakage, and mortality.