Nutritional Therapy

Our goal at Virginia Mason Hospital is to provide state-of-the-art nutritional therapy throughout a patient’s treatment and recovery. Nutrition, always essential to maintaining good health, becomes especially important after major surgery and other cancer treatments.

The journey to recovery following an esophagectomy involves several gradual steps before returning to a normal (or nearly normal) eating pattern. One must keep in mind that each individual is unique, so the old saying, “one size fits all” does not apply when it comes to a nutrition plan. Everyone progresses through the recovery phase of an illness at his or her own pace. For this reason, a registered dietitian (dietitians are professionals who have received specialized training in how food and nutrients work in the body) visits every patient soon after an esophagectomy. Working with a team of physicians, nurses, and the kitchen staff, the dietitian monitors the nutrition of each esophagectomy patient while in the hospital. In addition, the dietitian educates the patient and their family members, (or caregivers) to make sure the patient continues to receive good nutrition at home to allow the best recovery.

The dietitians focus on two main goals for nutrition care:

First: The dietitian (from here on referred to as an RD) will assess individuals’ nutrition needs, which includes determining how many calories are needed to heal while achieving or maintaining a healthy weight. She will then make recommendations for nutrition support, and monitor nutritional status throughout hospitalization.

Second: The RD will coordinate your home nutrition needs to ensure a smooth transition from hospital to home. She will make sure the patient and/or his or her caregivers understand the patient’s nutritional needs and feel comfortable about providing nutrition support at home.

Guidelines for Nutrition After Your Esophagectomy Operation
Remember, all diets are individualized for each person’s distinctive needs. Your RD will be discussing specific guidelines with each patient and their family in detail after surgery. As a rule, the diet begins with a liquid diet, then changes to pureed, then continues to increase to soft solid foods, until normal textures are tolerated.

As mentioned before, the time to progress from liquids to normal textures varies significantly from person to person, but it is generally at least 3 to 6 months before a normal or nearly normal diet is resumed.

A period of time for healing is necessary before a patient can eat an adequate quantity of food and resume regular textures. This is especially true if radiation or chemotherapy have preceded surgery. For this reason, during the operation, the surgeon will be placing a feeding tube into a part of the intestine, called the jejunum. We begin using this feeding tube to provide nutrition within a few days after surgery. A formula especially made for this purpose is used. This is called “enteral” feeding or more commonly referred to as “tube feedings.” In the beginning, the formula is given over a period of 24 hours for most patients.

Then there is a gradual transition to nighttime feedings by decreasing the time the enteral formula is given, and increasing its volume.

For most patients, the goal for home is to be able to get all the nutrition needed from enteral feeds during the night. This allows time during the day to resume normal activities, without enteral feedings. Normal activities as tolerated can be resumed with a feeding tube in place. It does not stop patients from doing any of their favorite activities, such as hiking, swimming, riding a bicycle, or any other activity allowed by the surgeon. During this time, the texture of food taken by mouth increases. When the amounts of food are able to increase, the enteral feedings are tapered off gradually, and are then eventually discontinued. Again, the timeframe for this varies, and may be affected by other cancer treatments after surgery, such as radiation or chemotherapy, should these be necessary.

We hope you find this information useful, and look forward to the opportunity to take care of your nutrition needs at Virginia Mason.