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 edition UICC/AJCC) evaluated by a multidisciplinary team; 8. Neoadjuvant therapy will be administered, which may entail preoperative chemo-radiotherapy, chemotherapy only, or a combination of immunotherapy such as anti-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 before surgery; 6. History of other malignancies in the past 5 years, except successfully treated basal-cell skin carcinoma and cervical tumors in situ; 7. Severe abnormalities of liver and kidney functions (ALT≥2 times the upper limit of normal; Total bilirubin Tbil≥2 upper limit of normal; Creatinine Cr≥2 upper limit of normal); 8. Metabolic disorders, including uncontrolled diabetes mellitus or fasting blood glucose ≥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 biologic agents 10. History of known allergy to any component of ORAL IMPACT®; 11. Pregnant or lactating women, women of childbearing potential with either a positive pregnancy test at baseline or not using a reliable and appropriate contraceptive method; 12. Refuse to sign the consent or unable to follow the study protocol; 13. Inappropriate to participate in this study judged by investigators.