EFFECTS OF EARLY ENTERAL NUTRITION ON PATIENTS AFTER GASTRECTOMY: A META-ANALYSIS
Meihong Chen*, Yini Dang, Jiajia Yang, Guoxin Zhang
gastroenterology department, The first affiliated hospital of nanjing medical university, Nanjing, Jiangsu, China
Background and Aim: Globally, gastric cancer (GC) is one of the most common malignant tumors and surgical resection is the most effective treatment for GC. Nowadays, strategies on improving the postoperative nutritional status and the prognosis of GC patients have been well studied. In order to evaluate the safety and efficacy of early enteral nutrition (EEN) in postoperative GC patients, we conducted this meta-analysis.
Methods: This study included eligible randomized controlled trials published from 1990 to May 2018, which observed EEN on GC patients after gastrectomy. The quality of the trials was assessed with the Cochrane risk of bias tool. Publication bias was assessed with funnel plots. Primary outcome was postoperative complications. Secondary outcome includes average exhaust time, length of stay and hospitalization expenses. Sub-group analysis was also performed. Pooled risk ratio (RR) or weighted mean difference (WMD) with its corresponding 95% confidence interval (CI) were used to estimate the primary and secondary outcomes between EEN groups and controls. This meta-analysis was conducted by fixed or random-effects models according to the heterogeneity.
Results: Fourteen studies involving a total of 2067 patients met the inclusion criteria. Overall, EEN could significantly decrease the occurrence of postoperative complications (RR=0.79; 95%CI: 0.66-0.93; P=0.005), promote intestinal peristalsis (WMD=13.10; 95%CI: 12.00-14.20; P=0.000), reduce the length of stay (WMD=2.08; 95%CI: 1.82-2.35; P=0.000) and lessen the hospitalization expenses (WMD=654.71; 95%CI: 502.46-806.95; P=0.000). In addition, there were significant differences in complications among subgroups stratified by the start time of EEN, type of surgery and methods of EEN.
Conclusion: Early enteral nutrition is effective and feasible for postoperative gastric cancer patients. The optimum time of EEN is 24 hours after surgery and oral feeding presents the best effect.
Keywords: Gastric cancer, Gastrectomy, Early enteral nutrition, Safety and efficacy.
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