Early Oral Feeding Post-Upper Gastrointestinal Tract Resection and Primary Anastomosis in Oncology

Lopes, Lilian Pinheiro; Menezes, Taysa Machado; Toledo, Diogo Oliveira; DE-Oliveira, Antônio Talvane Torres; Longatto‐Filho, Adhemar; Nascimento, José Eduardo de Aguilar

doi:10.1590/0102-672020180001e1359

Cited by 34 publications

(34 citation statements)

References 14 publications

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“…A 2015 randomized, controlled trial by Mahmoodzadeh et al[20] comparing early oral feeding on POD1 to delaying oral feeding after ROBF in patients undergoing transthoracic esophagectomy or total/partial gastrectomy also found that EOF alone was associated with shorter LOS, faster ROBF, and fewer readmissions. An observational cohort study from 2018 evaluating the timing of oral feeding after upper gastrointestinal surgery (including 24 esophagectomies) also found a significant decrease in LOS when patients were fed orally on POD1 vs POD3[21].…”

Section: Timing Of Feeding - Early Vs Delayedmentioning

confidence: 99%

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Zheng

Devin

Pucci

et al. 2019

WJG

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Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy. Variation in practices during the perioperative period exists including the type of nutrition started, the delivery route, and its timing. Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery, which can affect their ability to regain or maintain weight. Methods of feeding after an esophagectomy include total parenteral nutrition, nasoduodenal/nasojejunal tube feeding, jejunostomy tube feeding, and oral feeding. Recent evidence suggests that early oral feeding is associated with shorter LOS, faster return of bowel function, and improved quality of life. Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe, feasible, and cost-effective, albeit with limited data. However, data on anastomotic leaks is mixed, and some studies suggest that the incidence of leaks may be higher with early oral feeding. This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach. No definitive data is currently available to definitively answer this question, and further studies should look at how these early feeding regimens vary by surgical technique. This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.

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Section: Timing Of Feeding - Early Vs Delayedmentioning

confidence: 99%

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Zheng

Devin

Pucci

et al. 2019

WJG

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“…Moreover, Shoar et al[ 20 ] showed that for patients with upper gastrointestinal malignant tumors, EOF after surgery can lead to faster recovery and shorter postoperative hospitalization. Lopes et al[ 21 ] also indicated that early oral diet was safe and viable for patients undergoing upper gastrointestinal surgery. The studies of Laffitte et al[ 4 ] and Sierzega et al[ 5 ] showed that patients after radical gastrectomy could tolerate EOF, while there was no definite correlation between EOF and postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

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

Lu¹,

Wang²,

Xie³

et al. 2020

WJG

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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 5 th 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.

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“…Other studies have evaluated the early oral feeding in the direct postoperative esophagectomy period, showing that the early oral feeding was not associated with an increased incidence of vomiting and nausea, nor was it considered a risk factor for anastomotic leakage. Moreover, those patients who received early oral feeding have a shortened hospital stay (25).…”

Section: Enteral Feeding Route-oral Nasoenteric Catheter and Jejunosmentioning

confidence: 99%

Jejunostomy or nasojejunal tube after esophagectomy: a review of the literature

Santos¹,

Júnior²,

Wainstein³

et al. 2019

J. Thorac. Dis

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Patients undergoing esophagectomy for cancer are a difficult to treat group of patients. At diagnosis they will present some degree of malnutrition in up to 80% and the causes are from multifactorial origin: the inability of food ingestion, advanced age, taste disturbances, and morbidity related to neoadjuvant treatment. In order to restaure the nutritional status, enteral nutritional support is preferable to parenteral support because of the risks of septic complications associated with venous catheters. During the postoperative period, the oral route is often inaccessible in these patients due to swallowing disorders and eventually mechanical ventilation, and if possible, often it does not provide sufficient caloric amounts for postoperative energy balance. For these reasons, it is usually recommended additional nutritional support. There are few studies in the literature that specifically address which is the most adequate route for enteral nutrition in patients undergoing esophagectomy. Nasojejunal catheters present a higher incidence of local complications, such as displacement and occlusion, whereas jejunostomy is more associated with reinterventions for the treatment of complications secondary to extravasation. Although there is weak evidence in the literature and a lack of randomized, prospective and multicenter studies evaluating the best enteral nutrition route in the postoperative period of esophagectomy, the use of the nasoenteric catheter seems to be adequate due to its simplicity of positioning and low rates of severe complications. In this paper a review is performed of the evidence about this subject.

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Early Oral Feeding Post-Upper Gastrointestinal Tract Resection and Primary Anastomosis in Oncology

Cited by 34 publications

References 14 publications

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

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

Jejunostomy or nasojejunal tube after esophagectomy: a review of the literature

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