Hao T, Liu Q, Lv X, Qiu J, Zhang HR, Jiang HP. Efficacy and safety of early oral feeding in postoperative patients with upper gastrointestinal tumor: A systematic review and meta-analysis. World J Gastrointest Surg 2021; 13(7): 717-733 [PMID: 34354804 DOI: 10.4240/wjgs.v13.i7.717]
Corresponding Author of This Article
Hai-Ping Jiang, MD, Chief Doctor, Professor, Surgeon, Department of General Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road, Tianhe District, Guangzhou 510632, Guangdong Province, China. qwwer@139.com
Research Domain of This Article
Nutrition & Dietetics
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2021; 13(7): 717-733 Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.717
Efficacy and safety of early oral feeding in postoperative patients with upper gastrointestinal tumor: A systematic review and meta-analysis
Tao Hao, Qian Liu, Xin Lv, Jun Qiu, Hao-Ran Zhang, Hai-Ping Jiang
Tao Hao, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou 510632, Guangdong Province, China
Qian Liu, Department of Cardiology, The Affiliated Hospital of Binzhou Medical College, Binzhou 256600, Shandong Province, China
Xin Lv, Jun Qiu, Hao-Ran Zhang, Hai-Ping Jiang, Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
Author contributions: Hao T and Jiang HP conceived and designed the updated meta-analysis; Hao T, Qiu J and Zhang HR carried out the literature search, data extraction and statistical analysis, and drafted the manuscript; Liu Q, Lv X and Jiang HP were responsible for the retrieval strategy and assessment of the risk of bias, and provided critical supervision and revision of this article; all authors conducted detailed review and revision of the data and approved the final version of the manuscript.
Supported byDanone Nutrition Research and Education Foundation, No. DIC2020-03.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: All authors have read the PRISMA 2009 Checklist, and the manuscript was carefully prepared and revised based on the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Ping Jiang, MD, Chief Doctor, Professor, Surgeon, Department of General Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road, Tianhe District, Guangzhou 510632, Guangdong Province, China. qwwer@139.com
Received: March 29, 2021 Peer-review started: March 29, 2021 First decision: May 28, 2021 Revised: June 4, 2021 Accepted: June 22, 2021 Article in press: June 22, 2021 Published online: July 27, 2021
Abstract
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.
Core Tip: Postoperative early oral feeding (EOF) is safe and effective for improving clinical outcomes in patients with lower gastrointestinal tumor. To our knowledge, this study is the largest meta-analysis of randomized controlled trials to date, including 2100 participants, of whom 1042 received EOF protocols and 1058 received traditional oral feeding, to assess the safety and efficacy in postoperative patients with upper gastrointestinal tumor. Our review clarified that EOF results in accelerated convalescence, reduction of the risk of pneumonia, length of hospital and medical costs, and better immune status.
