Effects of early oral feeding after radical total gastrectomy in gastric cancer patients

BACKGROUND Gastric cancer(GC)is a heavy burden in China.Nutritional support for GC patients is closely related to postoperative rehabilitation.However,the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce.AIM To prospectively explore the safety,feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients.METHODS This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China.A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled.Of which,105 patients were given early oral feeding(EOF group)after surgery,and the other 101 patients were given the traditional feeding strategy(control group)after surgery.Perioperative clinical data were recorded and analyzed.The primary endpoints were gastrointestinal function recovery time and postoperative complications,and the secondary endpoints were postoperative nutritional status,length of hospital stay and expenses,etc.RESULTS Compared with the control group,patients in the EOF group had a significantly shorter postoperative first exhaust time(2.48±1.17 d vs 3.37±1.42 d,P=0.001)and first defecation time(3.83±2.41 d vs 5.32±2.70 d,P=0.004).In addition,the EOF group had a significant shorter postoperative hospitalization duration(5.85±1.53 d vs 7.71±1.56 d,P<0.001)and lower postoperative hospitalization expenses(16.60±5.10 K¥vs 21.00±7.50 K¥,P=0.014).On the 5th day after surgery,serum prealbumin level(214.52±22.47 mg/L vs 204.17±20.62 mg/L,P=0.018),serum gastrin level(246.30±57.10 ng/L vs 223.60±55.70 ng/L,P=0.001)and serum motilin level(424.60±68.30 ng/L vs 409.30±61.70 ng/L,P=0.002)were higher in the EOF group.However,there was no significant difference in the incidence of total postoperative complications between the two groups(P=0.507).CONCLUSION Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function,improve postoperative nutritional status,reduce length of hospital stay and expenses while not increasing the incidence of related complications,which indicates its safety,feasibility and potential benefits for gastric cancer patients.

Efficacy and safety of early oral feeding in postoperative patients with upper gastrointestinal tumor:A systematic review and metaanalysis

BACKGROUND Early oral feeding(EOF)is an important measure for early recovery of patients with gastrointestinal tumors after surgery,which has emerged as a safe and effective postoperative strategy for improving clinical outcomes.AIM To determine the safety and efficacy of early oral feeding in postoperative patients with upper gastrointestinal tumor.METHODS This meta-analysis was analyzed using Review Manager version 5.3 and Stata version 14.All clinical studies that analyzed efficacy and safety of EOF for postoperative patients with upper gastrointestinal tumor were included.RESULTS Fifteen studies comprising 2100 adult patients met all the inclusion criteria.A significantly lower risk of pneumonia was presented in the EOF compared with TOF group[relative risk(RR)=0.63,95%confidence interval(CI):0.44-0.89,P=0.01].Length of hospital stay was significantly shorter in the EOF group than in the TOF group[weighted mean difference(WMD)=-1.91,95%CI:-2.42 to-1.40;P<0.01].Cost of hospitalization was significantly lower(WMD=-4.16,95%CI:-5.72 to-2.61;P<0.01),and CD4 cell count and CD4/CD8 cell ratio on postoperative day 7 were significantly higher in the EOF group than in the TOF group:CD4 count(WMD=7.17,95%CI:6.48-7.85;P<0.01),CD4/CD8 ratio(WMD=0.29,95%CI:0.23-0.35;P<0.01).There was no significant difference in risk of anastomotic leak and total postoperative complications.CONCLUSION EOF as compared with TOF was associated with lower risk of pneumonia,shorter hospital length of stay,lower cost of hospitalization,and significantly improved postoperative immune function of patients.