After esophageal cancer surgery, as the stomach body becomes smaller and the cardia is removed, your stomach’s ability to swallow and hold food will be affected to some extent, and it will take a process to recover digestive and absorption functions. At this time, a proper diet and nutrition can help you improve your nutritional status, reduce the side effects of treatment, and improve your body’s tolerance of treatment.
The general dietary principles after surgery should be: small and frequent meals, from small to large, thin to thick, gradually transitioning to larger amounts, and avoiding extremes.
If your diet is slow to recover and you lose more than 1 to 2 kg in a week, this means that you are not getting enough nutrients to meet your recovery needs.
Patients undergoing esophageal and cardia resection surgery should specifically follow the following dietary principles:
1. Progressive
The esophagus and cardia are the “highways” of food transport. When they are partially removed, it is like a “road renovation”, so you can’t rush to “open the road” at this point.
- Postoperative healing period
It takes time for the surgical wound to heal, usually with a fast 7 to 14 days. Initially, you will need supplemental nutrition through enteral nutrition tube feeding or parenteral nutrition support.
Tube-feeding means that a very thin, specially made plastic tube is placed through a nasal or gastric stoma, straight into the jejunum, and nutrient solution is delivered to the body through this nutrition tube. Nutritional solutions are generally recommended to be formulated for special medical purposes (“special medical foods”), which are enteral nutrition preparations designed specifically for the patient. As long as the recommended amount is used, the body’s daily nutritional requirements can be met.
- Fluid, semi-liquid period
Your doctor will tell you when you can end your fast. At this time, you can usually only drink water or clear liquids (such as thin rice soup, thin lotus root powder, etc.).
About 7 days after surgery, you can try a small amount of liquid food as prescribed by your doctor. Start with 50 ml per meal and gradually increase to about 100-150 ml as you tolerate it. A pureed diet, such as rice paste, lotus root powder, solid yogurt, egg custard, bananas, and apple puree, is recommended at this stage to reduce the risk of choking and aspiration of food into the airway.
After 2 to 3 days on a liquid diet, you can transition to a semi-liquid diet. For example, meat and vegetable porridge, rotten noodles, lump soup, noodle soup, tender tofu, yogurt, mashed meatballs, steamed fish, tender leafy vegetables, steamed pumpkin, etc. Start with 80 ml per meal and gradually increase to about 150-200 ml as tolerated.
- Diet recovery period
About 1 to 2 months after surgery, the diet can be gradually transitioned to soft foods, such as soft noodles, soft rice, steamed buns, stewed meat, shredded meat, and fine soft vegetables. At this stage, care should be taken to separate dry and thin foods and to drink water or sweet gruel 30 minutes before and 1 hour after a meal to reduce the risk of reflux.
- Primary feeding period
After about 3 to 6 months, you can gradually transition to a general diet. During this period, you should pay attention to a reasonable mix of staple foods, protein, vegetables and fruits at each meal, and try to achieve a balanced diet. You can get an individualized recipe from a dietitian before you leave the hospital. When you get home, buy a home kitchen scale and weigh the daily amount of food to ensure that the type and quantity of food meets the nutritional needs.
2. Small, frequent meals
During the liquid and semi-liquid phase, the oral diet is often difficult to meet the body’s nutritional needs, and can be supplemented by oral “special medical food” (enteral nutrition preparation) 2 hours after three meals, 160-200 ml 3 times a day.
A full return to a normal diet usually takes 3 to 6 months. During this time, it is recommended that you adhere to the oral supplemental enteral nutrition preparation to avoid nutritional deficiencies that may lead to weight loss.
After returning to a normal diet, it is also recommended to eat 5 to 6 meals per day, i.e., 3 regular meals plus 2 to 3 small meals. The “small meals” can be ravioli, buns, noodles, bread, yogurt, fruit, etc. Also, you should monitor your weight.