Early initiation of oral feeding following upper gastrointestinal tumor surgery: a randomized controlled trial

Mahmoodzadeh, Habibollah; Shoar, Saeed; Sirati, Fereidoon; Khorgami, Zhamak

doi:10.1007/s00595-014-0937-x

Cited by 68 publications

(53 citation statements)

References 23 publications

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“…Nevertheless, in line with other types of gastro-intestinal surgery, early initiation of oral intake has been investigated. Four comparative trials did not observe an increased morbidity rate and anastomotic leakage or aspiration incidents did not increase (30)(31)(32)(33). However, a large randomized controlled trial in which patients are monitored in a multicenter setting is needed to evaluate the potentially beneficial impact of early oral intake on postoperative recovery and quality of life in patients undergoing esophagectomy.…”

Section: Conclusion (Discussion and Recommendations)mentioning

confidence: 99%

The feeding route after esophagectomy: a review of literature

et al. 2017

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Enhanced recovery programs effectively optimize perioperative care and reduce postoperative morbidity. In esophagectomy, several components of the ERAS program are successfully introduced. However, timing and type of postoperative feeding remain a matter of debate. Adequate nutritional support is essential in patients undergoing an esophagectomy. These patients often present with weight loss and their eating pattern is strongly altered by the procedure and reconstruction. Total parenteral nutrition (TPN) is associated with severe septic complications and enteral nutrition (EN) does not increase major complications. Therefore, early EN after esophagectomy is favored over TPN. However, with enteral feeding tubes minor complications occur frequently (13-38%) and in some cases this can hamper recovery. Based on experience in other types of upper gastro-intestinal surgery, early start of oral feeding could improve time to functional recovery after surgery. The total length of stay was significantly shorter in four prospective studies (6-12 8-13 days). However, large randomized controlled trials are lacking and the potential benefit of early oral feeding after esophageal surgery remains elusive. EN is nowadays the optimal feeding route after esophagectomy. TPN should only be used in specific cases in which EN is contraindicated. Early initiation of oral intake is promising and could improve postoperative recovery. However, further research is needed to substantiate these results.

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Section: Conclusion (Discussion and Recommendations)mentioning

confidence: 99%

The feeding route after esophagectomy: a review of literature

et al. 2017

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“…Nutrition support is divided into enteral nutrition and parenteral nutrition, which is an important means to promote patients' rehabilitation. EEN refers to giving the enteral nutrition support within postoperative 6–24 h ( 8 ). Parenteral nutrition is to provide the body with an appropriate amount of three major nutrients, vitamins, electrolytes and water through parenteral pathways (usually through veins), but how to better improve the postoperative nutritional status and control blood glucose level of patients with gastric cancer complicated with diabetes mellitus is the focus and difficulty of the current research.…”

Section: Discussionmentioning

confidence: 99%

Early enteral nutrition and total parenteral nutrition on the nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy

Wang¹,

Zhao²,

Zhang³

et al. 2018

Exp Ther Med

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Effects of early enteral nutrition (EEN) or total parenteral nutrition (TPN) support on nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy were investigated. One hundred and twenty-nine patients with gastric cancer complicated with diabetes mellitus type 2 admitted to the First People's Hospital of Jinan (Jinan, China), from June 2012 to June 2016 were selected into the study. According to different nutrition support pathways, these patients were randomly divided into the EEN group and the TPN group. The improvement of nutritional indexes, postoperative complications, gastrointestinal function recovery and perioperative blood glucose fluctuation were compared between the two groups. On the 4th day after operation, the improvement levels of total bilirubin (TBL), alanine aminotransferase (ALT), aspartate transaminase (AST), total protein (TP), prealbumin (PAB), hemoglobin (HGB) and weight (Wt) in the EEN group were significantly higher than those in the conventional group (P<0.05). There were no significant differences between the two groups on the 8th day after operation (P>0.05). No patients had complications in the EEN group, while a total of 29 patients in the TPN group suffered adverse reactions, indicating that the incidence rate of complications in the EEN group was significantly lower than that in the TPN group (P<0.05). The postoperative evacuation time was earlier, hospitalization time was shorter and cost of postoperative hospitalization was less in the EEN group than those in the TPN group, and the differences were statistically significant (P<0.05). The blood glucose fluctuation values at fasting and 2 h after a meal in the TPN group were higher than those in the EEN group within 8 days after operation, and the differences were statistically significant (χ2=13.219, P=0.002; χ2=20.527, P<0.001). EEN support provides nutrition for patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy, which is worthy of clinical promotion as it maintains good nutritional status, produces few postoperative complications and keeps the blood glucose level stable, by which the postoperative evacuation time is early, the hospitalization time is short and the cost is low.

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“…showed that early oral intake was safe and accelerated recovery. However, a substantial number of these patients underwent gastric surgery (34%), and the results were subjected to selection bias . Another study only included patients undergoing esophagectomy and showed faster postoperative gastric emptying …”

Section: Enhanced Recovery After Esophagectomymentioning

confidence: 99%

“…However, only a few patients who underwent an esophagectomy were included (2%). 163 A recent randomized trial by Mahmoodzadeh et al 164 showed that early oral intake was safe and accelerated recovery. However, a substantial number of these patients underwent gastric surgery (34%), and the results were subjected to selection bias.…”

Section: Enhanced Recovery After Esophagectomymentioning

confidence: 99%

“…However, a substantial number of these patients underwent gastric surgery (34%), and the results were subjected to selection bias. 164 Another study only included patients undergoing esophagectomy and showed faster postoperative gastric emptying. 165 In contrast, some retrospective cohort studies suggest that prolonged delay of oral intake (even up to 4 weeks) reduces anastomotic leakage rates and improves recovery.…”

Section: Enhanced Recovery After Esophagectomymentioning

confidence: 99%

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Stage‐directed individualized therapy in esophageal cancer

Goense

Rossum

Kandioler

et al. 2016

Annals of the New York Academy of Sciences

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Esophageal cancer is the eighth most common cancer worldwide, and the incidence of esophageal carcinoma is rapidly increasing. With the advent of new staging and treatment techniques, esophageal cancer can now be managed through various strategies. A good understanding of the advances and limitations of new staging techniques and how these can guide in individualizing treatment is important to improve outcomes for esophageal cancer patients. This paper outlines the recent progress in staging and treatment of esophageal cancer, with particularly attention to endoscopic techniques for early-stage esophageal cancer, multimodality treatment for locally advanced esophageal cancer, assessment of response to neoadjuvant treatment, and the role of cervical lymph node dissection. Furthermore, advances in robot-assisted surgical techniques and postoperative recovery protocols that may further improve outcomes after esophagectomy are discussed.

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Early initiation of oral feeding following upper gastrointestinal tumor surgery: a randomized controlled trial

Abstract: Early oral feeding after the surgical resection of esophageal and gastric tumors is safe, and is associated with favorable early in-hospital outcomes and a sooner return to physiological GI function and hospital discharge.

Cited by 68 publications

References 23 publications

The feeding route after esophagectomy: a review of literature

The feeding route after esophagectomy: a review of literature

Early enteral nutrition and total parenteral nutrition on the nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy

Stage‐directed individualized therapy in esophageal cancer

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