Prospective Study
Copyright ©The Author(s) 2020.
World J Gastroenterol. Sep 28, 2020; 26(36): 5508-5519
Published online Sep 28, 2020. doi: 10.3748/wjg.v26.i36.5508
Table 1 Dietary protocol of the early oral feeding group
Time pointProtocol
Day of surgeryAttempt to drink warm water (< 50 mL/h) 6 h after surgery was encouraged
Postoperative day 1Total oral fluid intake increased up to 500 mL, enteral nutrition preparation was given
Postoperative day 2Total oral fluid intake increased up to 1000 mL, liquid diet (such as small amounts of rice soup) started
Postoperative day 3Total oral fluid intake increased up to 1500 mL gradually, intravenous fluid volume gradually reduced
Postoperative day 4Frequent small amounts of oral fluids, small amounts of semi-liquid foods (such as porridge, noodles or other soft foods), intravenous fluids stopped if possible
Postoperative day 5Frequent small amounts of oral fluids with gradual transition to total semi-liquid diet and soft foods
Table 2 Baseline data of the two groups
Baseline dataEOF group, n = 105Control group, n = 101t valueP value
Gender, male/female, n88/1786/150.0050.942
Age, yr61.69 ± 10.8061.36 ± 11.721.3870.167
BMI, kg/m222.86 ± 4.7023.15 ± 4.32-0.7970.426
NRS-2002 score , < 3 or ≥ 3, n41/6438/630.0340.872
Preoperative serum PALB, mg/L227.50 ± 28.20225.41 ± 23.601.2690.264
Preoperative serum ALB, g/L39.24 ± 4.3638.58 ± 3.851.8330.076
Preoperative serum gastrin, ng/L212.40 ± 57.50211.70 ± 53.801.5120.134
Preoperative serum motilin, ng/L358.40 ± 67.10360.20 ± 68.70-1.9460.071
Operating time, min228.70 ± 31.20225.90 ± 29.471.2280.219
Blood loss, mL155.68 ± 51.35152.85 ± 52.461.2940.211
Pathological stage, n (%)0.0140.913
Stage I13 (12.38)11 (10.89)
Stage II48 (45.71)45 (44.55)
Stage III44 (41.91)45 (44.55)
Differentiation, n (%)0.0080.930
Poor52 (49.52)33 (49.25)
Moderate36 (34.29)23 (34.33)
Well17 (16.19)11 (16.42)
Borrmann types, n (%)0.2210.694
I8 (7.62)9 (8.91)
II34 (32.38)33 (32.67)
III47 (44.76)45 (44.56)
IV16 (15.24)14 (13.86)
Lauren types, n (%)0.6750.407
Intestinal type81 (77.14)74 (73.27)
Diffuse type24 (22.86)27 (26.73)
Table 3 Comparison of postoperative clinical data between the two groups
GroupEOF group, n = 105Control group, n = 101t valueP value
Postoperative gastrointestinal function recovery
First exhaust time, d2.48 ± 1.173.37 ± 1.42-63;4.460.001
First defecation time, d3.83 ± 2.415.32 ± 2.70-63;3.760.004
Postoperative hospitalization and expenses
Postoperative hospital stay, d5.85 ± 1.537.71 ± 1.56-63;5.32< 0.001
Hospitalization expenses, K¥16.60 ± 5.1021.00 ± 7.50-63;3.550.014
Postoperative nutritional status on the 5th day after surgery
Postoperative PALB, mg/L214.52 ± 22.47204.17 ± 20.622.850.018
Postoperative ALB, g/L36.24 ± 5.9335.16 ± 4.781.7440.079
Postoperative gastrointestinal hormone level on the 5th day after surgery
Postoperative serum gastrin, ng/L246.30 ± 57.10223.60 ± 55.707.4050.001
Postoperative serum motilin, ng/L424.60 ± 68.30409.30 ± 61.706.9460.002
Tolerance of oral feeding after surgery
Abdominal distension86
Postoperative nausea109
Reinsertion of nasogastric tube143
Total, %22 (20.95)18 (17.82)0.6640.507
Table 4 Comparison of postoperative complications between the two groups
GroupEOF group, n = 105Control group, n = 101t valueP value
Postoperative complications
Anastomotic bleeding12
Anastomotic or duodenal stump fistula31
Wound infection45
Postoperative pneumonia34
Postoperative ileus21
Others152
Total, %18 (17.14)15 (14.85)0.4220.609
Table 5 Univariate analysis of factors affecting the first exhaust time
IndexOR95%CIP value
Age, yr, < 60 or ≥ 600.4770.187-1.2210.123
Gender, male or female0.7640.241-1.1650.653
BMI, kg/m2, < 24 or ≥ 240.2360.116-0.4890.006
TNM stage, I or II or III0.7840.513-1.1480.242
Differentiation, poor, moderate, well0.8990.543-1.2560.308
Operation time, min, < 180 or ≥ 1800.5810.355-0.9530.042
Blood loss, mL, < mean or ≥ mean1.2100.884-1.5970.762
Early oral feeding, yes or no3.8621.840-9.6240.000
Postoperative serum gastrin, ng/L, < mean or ≥ mean0.2530.151-0.3570.000
Postoperative serum motilin, ng/L, < mean or ≥ mean0.6300.214-1.1070.163
Table 6 Multivariate analysis of factors affecting the first exhaust time
IndexOR95%CIP value
BMI, kg/m2, < 24 or ≥ 241.0600.649-1.7330.081
Operation time, min, < 180 or ≥ 1801.5190.578-3.9900.396
Early oral feeding, yes or no2.6891.289-3.783< 0.001
Postoperative serum gastrin, ng/L, < mean or ≥ mean0.4760.195-1.1620.103