Goal-directed Enteral Nutritional Perioperative Management

Inclusion Criteria:

1. Aged 18-80 years old;

2. ECOG PS 0~1;

3. NRS 2002 score ≥3;

4. Malnutrition diagnosed according to the GLIM criteria;

5. Histopathologically confirmed as esophageal squamous cell carcinoma;

6. Primary tumors located in thoracic esophagus;

7. Resectable locally advanced disease with clinical stage II to IVA (8th editionUICC/AJCC) evaluated by a multidisciplinary team;

8. Neoadjuvant therapy will be administered, which may entail preoperativechemo-radiotherapy, chemotherapy only, or a combination of immunotherapy such asanti-PD-1/PD-L1;

9. Informed consent for random assignment and completion of the protocol.

Exclusion Criteria:

1. NRS 2002 score < 3;

2. Upfront surgery without neoadjuvant treatment;

3. Any comorbidity interferes with the digestion and absorption of ORAL IMPACT®;

4. Receiving any other nutritional support during the study;

5. Unable to consume nutrition orally or receive it through tube feeding beforesurgery;

6. History of other malignancies in the past 5 years, except successfully treatedbasal-cell skin carcinoma and cervical tumors in situ;

7. Severe abnormalities of liver and kidney functions (ALT≥2 times the upper limit ofnormal; Total bilirubin Tbil≥2 upper limit of normal; Creatinine Cr≥2 upper limit ofnormal);

8. Metabolic disorders, including uncontrolled diabetes mellitus or fasting bloodglucose ≥10mmol/L, hypothyroidism, or hyperthyroidism;

9. Receiving fat emulsion containing Omega-3 fatty acids, glutamine, thymosin,glucocorticoid, thyroxine, growth hormone, and anti-tumor necrosis factor biologicagents

10. History of known allergy to any component of ORAL IMPACT®;

11. Pregnant or lactating women, women of childbearing potential with either a positivepregnancy test at baseline or not using a reliable and appropriate contraceptivemethod;

12. Refuse to sign the consent or unable to follow the study protocol;

13. Inappropriate to participate in this study judged by investigators.